Provider Demographics
NPI:1679868921
Name:JIZE, NICHOLAS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:R
Last Name:JIZE
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:12778 RANCHO PENASQUITOS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2946
Mailing Address - Country:US
Mailing Address - Phone:858-780-9794
Mailing Address - Fax:858-780-9690
Practice Address - Street 1:12778 RANCHO PENASQUITOS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2946
Practice Address - Country:US
Practice Address - Phone:858-780-9794
Practice Address - Fax:858-780-9690
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA623281223P0221X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223D0001XDental ProvidersDentistDental Public Health