Healthcare Provider Details

I. General information

NPI: 1730301516
Provider Name (Legal Business Name): PAUL K MIZOUE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W 120TH AVE SUITE 800
WESTMINSTER CO
80234-2714
US

IV. Provider business mailing address

1005 W 120TH AVE SUITE 800
WESTMINSTER CO
80234-2714
US

V. Phone/Fax

Practice location:
  • Phone: 303-452-2221
  • Fax: 303-450-9954
Mailing address:
  • Phone: 303-452-2221
  • Fax: 303-450-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105341
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: