Provider Demographics
NPI:1750448361
Name:LIZAN, BERNARDITA NAZAIRE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDITA
Middle Name:NAZAIRE
Last Name:LIZAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 EAST 8TH STREET 12
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2355
Mailing Address - Country:US
Mailing Address - Phone:619-477-7570
Mailing Address - Fax:619-477-5688
Practice Address - Street 1:550 EAST 8TH STREET SUITE 12
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2355
Practice Address - Country:US
Practice Address - Phone:619-477-7570
Practice Address - Fax:619-477-5688
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA037131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist