Organization
DAISY G. ISON, D.M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAISY GONZAGA ISON DDS (DENTIST)
(209) 952-2933
Entity
Organization
Contact information
Practice address
5345 N EL DORADO ST, SUITE 2, STOCKTON, CA 95207-5872
(209) 952-2933
(209) 952-2271
Mailing address
5345 N EL DORADO ST, SUITE, STOCKTON, CA 95207-5872
(209) 952-2933
(209) 952-2271
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
34120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1615122
UNITED CONCORDIA
PA
01
—
1B0K9G
BLUE CROSS
MA
01
—
542-42856
BLUE CROSS
AL
01
—
B34120-02
DELTA DENTAL
CA
Enumeration date
01/12/2007
Last updated
08/22/2020
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