Provider Demographics
NPI:1659546513
Name:ZISLIS, MURRAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MURRAY
Middle Name:
Last Name:ZISLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E LOS ANGELES AVE
Mailing Address - Street 2:224
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2033
Mailing Address - Country:US
Mailing Address - Phone:805-581-0144
Mailing Address - Fax:805-581-1013
Practice Address - Street 1:1720 E LOS ANGELES AVE
Practice Address - Street 2:224
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2033
Practice Address - Country:US
Practice Address - Phone:805-581-0144
Practice Address - Fax:805-581-1013
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice