Provider Demographics
NPI:1063503670
Name:PEZZOLLO, EUGENE P (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:P
Last Name:PEZZOLLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 FRANKLIN AVE
Mailing Address - Street 2:ST 110
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5795
Mailing Address - Country:US
Mailing Address - Phone:516-741-4415
Mailing Address - Fax:516-741-4417
Practice Address - Street 1:601 FRANKLIN AVE
Practice Address - Street 2:ST 110
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5795
Practice Address - Country:US
Practice Address - Phone:516-741-4415
Practice Address - Fax:516-741-4417
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery