Provider Demographics
NPI:1003269473
Name:BYRONSMIZUHA DMD,MSD, PS
Entity Type:Organization
Organization Name:BYRONSMIZUHA DMD,MSD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIZUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-771-3000
Mailing Address - Street 1:19320 40TH AVE W STE B
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4602
Mailing Address - Country:US
Mailing Address - Phone:425-771-3000
Mailing Address - Fax:425-771-1319
Practice Address - Street 1:19320 40TH AVE W STE B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4602
Practice Address - Country:US
Practice Address - Phone:425-771-3000
Practice Address - Fax:425-771-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4650125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty