Provider Demographics
NPI:1841367596
Name:IZZARD, WILLIAM RUDY (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUDY
Last Name:IZZARD
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 1:2141 HAMILTON WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6831
Mailing Address - Country:US
Mailing Address - Phone:325-949-6656
Mailing Address - Fax:325-947-2423
Practice Address - Street 1:2141 HAMILTON WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6831
Practice Address - Country:US
Practice Address - Phone:325-949-6656
Practice Address - Fax:325-947-2423
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice