Active NPI
William Arthur Lyzak Jr., DMD
- Prosthodontics
- Valparaiso, IN
National Provider Identifier
1972920965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 12010025A
- Practice address
- 402 Marquette St
Valparaiso, IN 46383-2563 - Phone
- (219) 465-4008
- Fax
- (219) 462-0283
- NPI assigned
- Mar 27, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 12010025A | IN | Primary |
Addresses
Primary practice location
402 Marquette St
Valparaiso, IN 46383-2563
Mailing address
402 Marquette St
Valparaiso, IN 46383-2563
Phone (219) 465-4008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12010025A | IN | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Accent Dental | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dentist
- Valparaiso, IN
- NPI 1912363953
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395878400000",
"number": "1972920965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 MARQUETTE ST",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463832563",
"telephone_number": "219-465-4008",
"fax_number": "219-462-0283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 MARQUETTE ST",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463832563",
"telephone_number": "219-465-4008",
"fax_number": "219-462-0283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYZAK",
"first_name": "WILLIAM",
"middle_name": "ARTHUR",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-27",
"last_updated": "2014-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "IN",
"license": "12010025A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.