Provider Demographics
NPI:1982043808
Name:KIZY, AMBER DANIAL (DDS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DANIAL
Last Name:KIZY
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 1:350 NORTH CLARK ST 6TH FLOOR
Mailing Address - Street 2:DENTAL DREAMS LLC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 N. CLARK STREET 6TH FLOOR
Practice Address - Street 2:DENTAL DREAMS C/O DANIELLE
Practice Address - City:CHIGAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:248-506-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist