Individual
DR. CHARLES ANTHONY ISELBORN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
149 BRIGHTON AVE, PORTLAND, ME 04102-2312
(207) 774-0546
Mailing address
149 BRIGHTON AVE, PORTLAND, ME 04102-2312
(207) 774-0546
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3136
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3136
DENTAL LICENSE NUMBER
ME
Enumeration date
06/06/2006
Last updated
07/08/2007
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