Provider Demographics
NPI:1467126508
Name:DIZAK, PIPER MADISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:PIPER
Middle Name:MADISON
Last Name:DIZAK
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 1:12300 INWOOD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-8032
Mailing Address - Country:US
Mailing Address - Phone:972-233-4439
Mailing Address - Fax:
Practice Address - Street 1:12300 INWOOD RD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-8032
Practice Address - Country:US
Practice Address - Phone:972-233-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX371781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry