Basic Information
| Provider Information | |||||||||
| NPI: | 1821361809 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANTHONY J. GAZZOLA, JR DMD PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6810 POST RD | ||||||||
| Address2: | |||||||||
| City: | NORTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028522137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018841525 | ||||||||
| FaxNumber: | 4018849538 | ||||||||
| Practice Location | |||||||||
| Address1: | 6810 POST RD | ||||||||
| Address2: | |||||||||
| City: | NORTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028522137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018841525 | ||||||||
| FaxNumber: | 4018849538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2012 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | GAZZOLA | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4018841525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN02979 | RI | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.