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Individual

DR. MARIE BEVERLY DIZON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.D.S., M.S.

Contact information

Practice address
1516 STARDUST DR, WEST COVINA, CA 91790-4558
(626) 643-6911
Mailing address
1516 STARDUST DR, WEST COVINA, CA 91790-4558
(626) 643-6911

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
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