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Organization
KENNETH G MIZE DMDPC
Active
Organization
KENNETH G MIZE DMDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH G MIZE DMD (PRESIDENT)
(503) 843-4433
Entity
Organization
Contact information
Practice address
411 W MAIN ST, SHERIDAN, OR 97378-1117
(503) 843-4433
(503) 843-4434
Mailing address
411 W MAIN ST, P.O. BOX 100, SHERIDAN, OR 97378-1117
(503) 843-4433
(503) 843-4434
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5811
OR
Other
Enumeration date
04/05/2007
Last updated
08/22/2020
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