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General NPI Number Information
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NPI Number | 1265921878
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Entity Type | Individual
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Provider Name | MARK ALEXANDER NIZZA DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 4607 LEAP CT
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City | HILLIARD
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State | OH
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Zip | 43026-1174
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Country | US
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Telephone | 614-885-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 3367 DOUGLAS RD
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City | SOUTH BEND
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State | IN
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Zip | 46635-1779
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Country | US
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Telephone | 574-272-8823
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Fax | 574-277-1837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30.025947
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 12013970A
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License Number State | IN
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