Provider Demographics
NPI:1750622676
Name:BIZGA, TIMOTHY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:BIZGA
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 1:6731 RIDGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5708
Mailing Address - Country:US
Mailing Address - Phone:440-884-6644
Mailing Address - Fax:440-884-6691
Practice Address - Street 1:6731 RIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5708
Practice Address - Country:US
Practice Address - Phone:440-884-6644
Practice Address - Fax:440-884-6691
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist