Provider Demographics
NPI:1730252750
Name:BIZEAU, RYAN ZEPHYR (DMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ZEPHYR
Last Name:BIZEAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SITKA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1303
Mailing Address - Country:US
Mailing Address - Phone:503-538-6100
Mailing Address - Fax:503-538-7577
Practice Address - Street 1:500 SITKA AVE
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1303
Practice Address - Country:US
Practice Address - Phone:503-538-6100
Practice Address - Fax:503-538-7577
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice