Healthcare Provider Details

I. General information

NPI: 1619135605
Provider Name (Legal Business Name): NANCY MIZUNO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 N CENTRAL EXPY STE 250
PLANO TX
75023-6912
US

IV. Provider business mailing address

4801 S BUCKNER BLVD STE 800
DALLAS TX
75227-2377
US

V. Phone/Fax

Practice location:
  • Phone: 972-881-1275
  • Fax:
Mailing address:
  • Phone: 214-275-4808
  • Fax: 281-916-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23877
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number23877
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: