Provider Demographics
NPI:1306375936
Name:NICHOLAS JIZE DDS, INC
Entity Type:Organization
Organization Name:NICHOLAS JIZE DDS, INC
Other - Org Name:FIRST TOOTH PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-227-4916
Mailing Address - Street 1:2775 VIA DE LA VALLE STE 103
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1919
Mailing Address - Country:US
Mailing Address - Phone:858-227-4916
Mailing Address - Fax:858-947-3287
Practice Address - Street 1:2775 VIA DE LA VALLE STE 103
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1919
Practice Address - Country:US
Practice Address - Phone:858-227-4916
Practice Address - Fax:858-947-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty