Provider Demographics
NPI:1144247107
Name:LIVIZ, ANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:LIVIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 BLYTHE ST
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3645
Mailing Address - Country:US
Mailing Address - Phone:650-574-3366
Mailing Address - Fax:650-343-2225
Practice Address - Street 1:324 N SAN MATEO DR STE 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2514
Practice Address - Country:US
Practice Address - Phone:650-343-5555
Practice Address - Fax:650-343-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42175-01Medicaid