Provider Demographics
NPI:1386723963
Name:KIZZIAR, JOHN W (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KIZZIAR
Suffix:
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:PO BOX 36
Mailing Address - Street 2:#1 BRADY ROAD
Mailing Address - City:HAYFORK
Mailing Address - State:CA
Mailing Address - Zip Code:96041-0036
Mailing Address - Country:US
Mailing Address - Phone:530-628-4271
Mailing Address - Fax:530-628-4064
Practice Address - Street 1:#1 BRADY ROAD
Practice Address - Street 2:
Practice Address - City:HAYFORK
Practice Address - State:CA
Practice Address - Zip Code:96041-0036
Practice Address - Country:US
Practice Address - Phone:530-628-4271
Practice Address - Fax:530-628-4064
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice