Provider Demographics
NPI:1073733259
Name:BIZEAU DENTAL LLC
Entity Type:Organization
Organization Name:BIZEAU DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ZEPHYR
Authorized Official - Last Name:BIZEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-538-6100
Mailing Address - Street 1:500 SITKA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1303
Mailing Address - Country:US
Mailing Address - Phone:503-538-6100
Mailing Address - Fax:503-538-7577
Practice Address - Street 1:500 SITKA AVE
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1303
Practice Address - Country:US
Practice Address - Phone:503-538-6100
Practice Address - Fax:503-538-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR83071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty