Individual
BLAIR ALEXANDER ISOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9368 BRONZE RIVER AVE, LAS VEGAS, NV 89149-1687
(509) 822-8725
Mailing address
9368 BRONZE RIVER AVE, LAS VEGAS, NV 89149-1687
(509) 822-8725
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
58883
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DE60351030
WA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
S2-144C
NV
Other
Enumeration date
04/20/2012
Last updated
06/27/2016
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