Provider Demographics
NPI:1972920965
Name:LYZAK, WILLIAM ARTHUR JR (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:LYZAK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2563
Mailing Address - Country:US
Mailing Address - Phone:219-465-4008
Mailing Address - Fax:219-462-0283
Practice Address - Street 1:402 MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2563
Practice Address - Country:US
Practice Address - Phone:219-465-4008
Practice Address - Fax:219-462-0283
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010025A1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics