Individual
DR. MICHAEL JAY RAIZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
600 W 3RD ST, MANSFIELD, OH 44906-2633
(419) 522-1939
Mailing address
600 W 3RD ST, MANSFIELD, OH 44906-2633
(419) 522-1939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22695
OH
1223G0001X
General Practice Dentistry
106233
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02062339
—
CO
Enumeration date
06/02/2005
Last updated
08/09/2010
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