| Fantuzzo Oral, Maxillofacial, And Dental Implant Surgery, Pllc | |
|
77 Mahogany Run Pittsford NY 14534-9424 | |
| (585) 203-1524 | |
| Not Available |
| Full Name | Fantuzzo Oral, Maxillofacial, And Dental Implant Surgery, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 77 Mahogany Run, Pittsford, New York |
| Authorized Official Name and Position | Joseph J Fantuzzo (OWNER/PROVIDER) |
| Authorized Official Contact | 5852031524 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fantuzzo Oral, Maxillofacial, And Dental Implant Surgery, Pllc 1815 Clinton Ave. South Suite 320 Rochester NY 14618 Ph: () - | Fantuzzo Oral, Maxillofacial, And Dental Implant Surgery, Pllc 77 Mahogany Run Pittsford NY 14534-9424 Ph: (585) 203-1524 |
| NPI Number | 1275925380 |
|---|---|
| Provider Enumeration Date | 02/26/2015 |
| Last Update Date | 02/26/2015 |
| Medicare PECOS PAC ID | 4486957388 |
|---|---|
| Medicare Enrollment ID | O20160127001615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275925380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 048604 (New York) | Primary |
| Provider Name | Joseph J Fantuzzo |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1073620373 PECOS PAC ID: 8729033949 Enrollment ID: I20050321000367 |
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