Provider Demographics
NPI:1346320975
Name:CHANIZI, SUSSAN (DDS)
Entity Type:Individual
Prefix:
First Name:SUSSAN
Middle Name:
Last Name:CHANIZI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E SIERRA AVE
Mailing Address - Street 2:APT 123
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3600
Mailing Address - Country:US
Mailing Address - Phone:559-431-2937
Mailing Address - Fax:
Practice Address - Street 1:2000 FRESNO ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1708
Practice Address - Country:US
Practice Address - Phone:559-442-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist