Provider Demographics
NPI:1366511784
Name:BLIZZARD, WILLIAM HENRY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:BLIZZARD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 WHIRLAWAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7836
Mailing Address - Country:US
Mailing Address - Phone:915-790-0422
Mailing Address - Fax:
Practice Address - Street 1:2112 TRAWOOD DR
Practice Address - Street 2:SUITE A-2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3372
Practice Address - Country:US
Practice Address - Phone:915-598-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice