Mark Alexander Nizza, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30.025947 Issued in OH

Practice address

4607 Leap CT
Hilliard, OH 43026-1174

Phone

(614) 885-3339

NPI assigned

May 9, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edison Lakes Oral Surgery, P.C.

  dba Oral Surgery Michiana

  • Oral and Maxillofacial Surgery Clinic/Center
  • South Bend, IN
  • NPI 1881887065
  NPD
• Carnes, Montgomery, Cook & Henry, Oral & Max Surg, LLC

  dba Northwest Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Worthington, OH
  • NPI 1336166289
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1265921878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3367 DOUGLAS RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351779",
            "telephone_number": "574-272-8823",
            "fax_number": "574-277-1837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4607 LEAP CT",
            "city": "HILLIARD",
            "state": "OH",
            "postal_code": "430261174",
            "telephone_number": "614-885-3339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6641 N High St Ste 105",
            "address_purpose": "LOCATION",
            "city": "Worthington",
            "state": "OH",
            "postal_code": "430854038",
            "country_code": "US",
            "telephone_number": "614-885-3339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5101 Forest Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "OH",
            "postal_code": "430548226",
            "country_code": "US",
            "telephone_number": "614-885-3339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIZZA",
        "first_name": "MARK",
        "middle_name": "ALEXANDER",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-09",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30.025947",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IN",
            "license": "12013970A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Hilliard, OH
• Providers in Hilliard, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.