Healthcare Provider Details

I. General information

NPI: 1073733259
Provider Name (Legal Business Name): BIZEAU DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SITKA AVE
NEWBERG OR
97132-1303
US

IV. Provider business mailing address

500 SITKA AVE
NEWBERG OR
97132-1303
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-6100
  • Fax: 503-538-7577
Mailing address:
  • Phone: 503-538-6100
  • Fax: 503-538-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8307
License Number StateOR

VIII. Authorized Official

Name: DR. RYAN ZEPHYR BIZEAU
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 503-538-6100