Provider Demographics
NPI:1205214335
Name:GAYLE M. PEZZULO D.M.D.,P.C.
Entity Type:Organization
Organization Name:GAYLE M. PEZZULO D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEZZULO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-356-1800
Mailing Address - Street 1:480 ADAMS ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4914
Mailing Address - Country:US
Mailing Address - Phone:617-698-9401
Mailing Address - Fax:
Practice Address - Street 1:480 ADAMS ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4914
Practice Address - Country:US
Practice Address - Phone:617-698-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty