Provider Demographics
NPI:1073978268
Name:BIZRA, EAMON (DDS MPH)
Entity Type:Individual
Prefix:DR
First Name:EAMON
Middle Name:
Last Name:BIZRA
Suffix:
Gender:M
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 EMPIRE CV
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3480
Mailing Address - Country:US
Mailing Address - Phone:512-400-5111
Mailing Address - Fax:
Practice Address - Street 1:9225 W PARMER LN STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4694
Practice Address - Country:US
Practice Address - Phone:512-955-5500
Practice Address - Fax:512-955-5600
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice