Individual
DR. DONALD EDWARD ISSELHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12401 OLIVE BLVD, SUITE 200, CREVE COEUR, MO 63141-5448
(314) 275-9009
(314) 275-9010
Mailing address
12401 OLIVE BLVD, SUITE 200, CREVE COEUR, MO 63141-5448
(314) 275-9009
(314) 275-9010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10765
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200666093
CORPRATION TAX ID
MO
01
—
793073
UNITED CONCORDIA
PA
Enumeration date
08/31/2006
Last updated
07/08/2007
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