Individual
MICHAEL SCOTT ISHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1015 CALLE GARZA NE, ALBUQUERQUE, NM 87113-1249
(505) 610-0163
Mailing address
1015 CALLE GARZA NE, ALBUQUERQUE, NM 87113-1249
(505) 610-0163
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD4733
NM
Other
Enumeration date
07/13/2017
Last updated
07/21/2022
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