Provider Demographics
NPI:1295835809
Name:EZIS, ILMAR (DDS)
Entity Type:Individual
Prefix:
First Name:ILMAR
Middle Name:
Last Name:EZIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 GOLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2003
Mailing Address - Country:US
Mailing Address - Phone:513-533-1223
Mailing Address - Fax:513-871-8490
Practice Address - Street 1:4030 SMITH RD
Practice Address - Street 2:STE 225
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1957
Practice Address - Country:US
Practice Address - Phone:513-871-8488
Practice Address - Fax:513-871-8490
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300142841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice