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General NPI Number Information
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NPI Number | 1306375936
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Entity Type | Organization
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Legal Business Name | NICHOLAS JIZE DDS, INC
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2775 VIA DE LA VALLE STE 103
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City | DEL MAR
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State | CA
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Zip | 92014-1919
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Country | US
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Telephone | 858-227-4916
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Fax | 858-947-3287
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Provider Business Mailing Address
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Address Line | 2775 VIA DE LA VALLE STE 103
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City | DEL MAR
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State | CA
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Zip | 92014-1919
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Country | US
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Telephone | 858-227-4916
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Fax | 858-947-3287
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | EMMA MADANY
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Credential |
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Telephone | 858-227-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 62328
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License Number State | CA
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