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General NPI Number Information
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NPI Number | 1053514349
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Entity Type | Organization
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Legal Business Name | DIZON AND LAM DMD INC.
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 520 COTTONWOOD ST STE 9
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City | WOODLAND
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State | CA
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Zip | 95695-3603
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Country | US
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Telephone | 530-662-8100
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Fax | 530-662-8101
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Provider Business Mailing Address
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Address Line | 520 COTTONWOOD ST STE 9
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City | WOODLAND
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State | CA
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Zip | 95695-3603
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Country | US
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Telephone | 530-662-8100
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Fax | 530-662-8101
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Authorized Official
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Title or Position | DENTIST
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Name | BRENDA OLIMPIADA DIZON
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Credential |
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Telephone | 530-662-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37072
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License Number State | CA
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