Provider Demographics
NPI:1225051907
Name:LAIZURE, DANIS LYLE (DMD,FAGD)
Entity Type:Individual
Prefix:
First Name:DANIS
Middle Name:LYLE
Last Name:LAIZURE
Suffix:
Gender:M
Credentials:DMD,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4532
Mailing Address - Country:US
Mailing Address - Phone:509-525-4833
Mailing Address - Fax:509-525-0832
Practice Address - Street 1:2014 S HOWARD ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4532
Practice Address - Country:US
Practice Address - Phone:509-525-4833
Practice Address - Fax:509-525-0832
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00049461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE0004946OtherSTATE LICENSE
WA911868526OtherT.I.N.
WAAL9497555OtherDEA #