Provider Demographics
NPI:1033357892
Name:DIZON, EUNICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:
Last Name:DIZON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 PAXTON CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7016
Mailing Address - Country:US
Mailing Address - Phone:510-818-0147
Mailing Address - Fax:
Practice Address - Street 1:22331 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3911
Practice Address - Country:US
Practice Address - Phone:510-471-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-31
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice