Healthcare Provider Details

I. General information

NPI: 1043964026
Provider Name (Legal Business Name): CHRISTINE RENEE' MIZE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PINE MANOR DR
OAK RIDGE NORTH TX
77385-9059
US

IV. Provider business mailing address

170 E BRACEBRIDGE CIR
THE WOODLANDS TX
77382-2541
US

V. Phone/Fax

Practice location:
  • Phone: 281-364-7914
  • Fax:
Mailing address:
  • Phone: 281-536-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17662
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: