Provider Demographics
NPI:1174646780
Name:DIZON, MERLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERLYN
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 1:44207 20TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4060
Mailing Address - Country:US
Mailing Address - Phone:661-942-8333
Mailing Address - Fax:661-942-3003
Practice Address - Street 1:44207 20TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4060
Practice Address - Country:US
Practice Address - Phone:661-942-8333
Practice Address - Fax:661-942-3003
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice