Individual
DR. MARIE BEVERLY DIZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S., M.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
63959
CA
1223P0221X
Pediatric Dentistry
Primary
63959
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63959
CA DENTAL LICENSE
CA
Enumeration date
05/04/2016
Last updated
03/02/2020
Update your record
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