Provider Demographics
NPI:1043964026
Name:MIZE, CHRISTINE RENEE' (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:RENEE'
Last Name:MIZE
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 1:170 E BRACEBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2541
Mailing Address - Country:US
Mailing Address - Phone:281-536-0240
Mailing Address - Fax:
Practice Address - Street 1:101 PINE MANOR DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE NORTH
Practice Address - State:TX
Practice Address - Zip Code:77385-9059
Practice Address - Country:US
Practice Address - Phone:281-364-7914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17662OtherFREE DENTAL CARE