Provider Demographics
NPI:1093726705
Name:IZZO, KAREN ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:IZZO
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 1:4501 N CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-4278
Mailing Address - Country:US
Mailing Address - Phone:708-453-5320
Mailing Address - Fax:708-583-1945
Practice Address - Street 1:4501 N CUMBERLAND AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706
Practice Address - Country:US
Practice Address - Phone:708-453-5320
Practice Address - Fax:708-583-1945
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist