Provider Demographics
NPI:1740294065
Name:ANIZOR, ISIOMA (DDS)
Entity type:Individual
Prefix:DR
First Name:ISIOMA
Middle Name:
Last Name:ANIZOR
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 1:4825 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8800
Mailing Address - Country:US
Mailing Address - Phone:770-962-4322
Mailing Address - Fax:678-407-2787
Practice Address - Street 1:4825 SUGARLOAF PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8800
Practice Address - Country:US
Practice Address - Phone:770-962-4322
Practice Address - Fax:678-407-2787
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice