Provider Demographics
NPI:1376885475
Name:DIZIK, DIANA (DDS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DIZIK
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 1:669 CRESPI DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3486
Mailing Address - Country:US
Mailing Address - Phone:650-359-1646
Mailing Address - Fax:
Practice Address - Street 1:669 CRESPI DR
Practice Address - Street 2:SUITE F
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3486
Practice Address - Country:US
Practice Address - Phone:650-359-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist