Provider Demographics
NPI:1003037532
Name:JOHN L IZANEC DDS PA
Entity Type:Organization
Organization Name:JOHN L IZANEC DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:IZANEC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-852-3219
Mailing Address - Street 1:PO 639
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070
Mailing Address - Country:US
Mailing Address - Phone:305-852-3219
Mailing Address - Fax:305-852-9016
Practice Address - Street 1:91750 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070
Practice Address - Country:US
Practice Address - Phone:305-852-3219
Practice Address - Fax:305-852-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 6839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty