Provider Demographics
NPI:1376160549
Name:EZZI, INSIYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:INSIYA
Middle Name:
Last Name:EZZI
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 1:21306 WILLOWFORD PARK DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5447
Mailing Address - Country:US
Mailing Address - Phone:813-777-2407
Mailing Address - Fax:
Practice Address - Street 1:21306 WILLOWFORD PARK DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5447
Practice Address - Country:US
Practice Address - Phone:813-777-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist