Provider Demographics
NPI:1336298132
Name:DIZON, TERESITA LAYUG (DMD)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:LAYUG
Last Name:DIZON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 S WHITE RD
Mailing Address - Street 2:SUITE 90
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2076
Mailing Address - Country:US
Mailing Address - Phone:408-223-7414
Mailing Address - Fax:408-223-2465
Practice Address - Street 1:2690 S WHITE RD
Practice Address - Street 2:SUITE 90
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2076
Practice Address - Country:US
Practice Address - Phone:408-223-7414
Practice Address - Fax:408-223-2465
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice