Individual
ELIZABETH MIZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11412 J B HOLIDAY RD, BOGALUSA, LA 70427-0998
(985) 735-9722
Mailing address
11412 J B HOLIDAY RD, BOGALUSA, LA 70427-0998
(985) 735-9722
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3JC45237159V
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009233563
DRIVER LICENSE
LA
Enumeration date
06/12/2021
Last updated
06/12/2021
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