Provider Demographics
NPI:1720113194
Name:CHIZMAR, PAUL D (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:CHIZMAR
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:CONOWINGO
Mailing Address - State:MD
Mailing Address - Zip Code:21918-0099
Mailing Address - Country:US
Mailing Address - Phone:410-378-9696
Mailing Address - Fax:410-378-0787
Practice Address - Street 1:49 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CONOWINGO
Practice Address - State:MD
Practice Address - Zip Code:21918-1352
Practice Address - Country:US
Practice Address - Phone:410-378-9696
Practice Address - Fax:410-378-0787
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist