Provider Demographics
NPI:1457449373
Name:NIZICH, ANTHONY FRANCIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:NIZICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8050
Mailing Address - Country:US
Mailing Address - Phone:907-789-7001
Mailing Address - Fax:907-789-7008
Practice Address - Street 1:2219 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-789-7001
Practice Address - Fax:907-789-7008
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice