Healthcare Provider Details

I. General information

NPI: 1417009333
Provider Name (Legal Business Name): MICHAEL ANTHONY ZIZELMANN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 LOUETTA RD SUITE B
SPRING TX
77379-7568
US

IV. Provider business mailing address

6526 LOUETTA RD SUITE B
SPRING TX
77379-7568
US

V. Phone/Fax

Practice location:
  • Phone: 281-370-5555
  • Fax: 281-370-5555
Mailing address:
  • Phone: 281-370-5555
  • Fax: 281-370-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16949
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: