Provider Demographics
NPI:1659072270
Name:CZYZ, MARIA JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:JANE
Last Name:CZYZ
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 1:4915 25TH AVE NE SUITE 205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-524-1600
Mailing Address - Fax:
Practice Address - Street 1:4915 25TH AVE SUITE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-524-1600
Practice Address - Fax:206-524-1603
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-10-23
Deactivation Date:2023-10-12
Deactivation Code:
Reactivation Date:2023-10-23
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADR614258521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program