Provider Demographics
NPI:1578577862
Name:CLARK A IZU DDS INC
Entity Type:Organization
Organization Name:CLARK A IZU DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:IZU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-544-7033
Mailing Address - Street 1:20 MARYLAND
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1739
Mailing Address - Country:US
Mailing Address - Phone:949-653-8204
Mailing Address - Fax:
Practice Address - Street 1:20 MARYLAND
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1739
Practice Address - Country:US
Practice Address - Phone:949-653-8204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty