Provider Demographics
NPI:1093922833
Name:PIZIKS, BETHANY M (DDS)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:M
Last Name:PIZIKS
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 1:300 PALUSTER ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2552
Mailing Address - Country:US
Mailing Address - Phone:231-779-2402
Mailing Address - Fax:231-779-5902
Practice Address - Street 1:300 PALUSTER ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2552
Practice Address - Country:US
Practice Address - Phone:231-779-2402
Practice Address - Fax:231-779-5902
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI164991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice