Healthcare Provider Details

I. General information

NPI: 1417953100
Provider Name (Legal Business Name): DEBORAH L KIZZIAR D.D.S., M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W FRANCIS AVE
SPOKANE WA
99205-6348
US

IV. Provider business mailing address

ORAL SURGERY PLUS 123 W FRANCIS
SPOKANE WA
99205
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-8800
  • Fax: 509-321-0154
Mailing address:
  • Phone: 509-928-8800
  • Fax: 509-321-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8428
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: