Individual
DR. EDISON A ISHAYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3855 W NORTH AVE, CHICAGO, IL 60647-4640
(773) 782-8900
(773) 782-0577
Mailing address
3855 W NORTH AVE, CHICAGO, IL 60647-4640
(773) 782-8900
(773) 782-0577
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002613
—
IL
05
—
103068
—
IL
Enumeration date
03/02/2007
Last updated
07/09/2007
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