Provider Demographics
NPI:1780803668
Name:KIZIOR, JOHN WILLIAM (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:KIZIOR
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2005 ST CHARLES ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9146
Mailing Address - Country:US
Mailing Address - Phone:812-634-2040
Mailing Address - Fax:812-482-7405
Practice Address - Street 1:2005 ST CHARLES ST
Practice Address - Street 2:SUITE 3
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9146
Practice Address - Country:US
Practice Address - Phone:812-634-2040
Practice Address - Fax:812-482-7405
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010318A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics