Provider Demographics
NPI:1558592865
Name:MIRAZIZ, LINA A (DDS)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:A
Last Name:MIRAZIZ
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:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:COWPENS
Mailing Address - State:SC
Mailing Address - Zip Code:29330-0298
Mailing Address - Country:US
Mailing Address - Phone:864-463-3232
Mailing Address - Fax:
Practice Address - Street 1:5185 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COWPENS
Practice Address - State:SC
Practice Address - Zip Code:29330-9254
Practice Address - Country:US
Practice Address - Phone:864-463-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist