Provider Demographics
NPI:1306001169
Name:KIZIOR, MARK J (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:KIZIOR
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3106 WILLOW AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4749
Mailing Address - Country:US
Mailing Address - Phone:559-292-7342
Mailing Address - Fax:559-292-8989
Practice Address - Street 1:3106 WILLOW AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4749
Practice Address - Country:US
Practice Address - Phone:559-292-7342
Practice Address - Fax:559-292-8989
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0390281223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics