Provider Demographics
NPI:1063613743
Name:KIZIOR, LESLEY SUZANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:SUZANNE
Last Name:KIZIOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1820
Mailing Address - Country:US
Mailing Address - Phone:812-556-6500
Mailing Address - Fax:812-556-6501
Practice Address - Street 1:825 W 13TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1820
Practice Address - Country:US
Practice Address - Phone:812-556-6500
Practice Address - Fax:812-556-6501
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist