Provider Demographics
NPI:1245405448
Name:INTRIVICI, EZIA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:EZIA
Middle Name:A
Last Name:INTRIVICI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 PARSIPPANY RD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-5102
Mailing Address - Country:US
Mailing Address - Phone:973-428-1515
Mailing Address - Fax:
Practice Address - Street 1:362 PARSIPPANY RD
Practice Address - Street 2:SUITE A-4
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-5102
Practice Address - Country:US
Practice Address - Phone:973-428-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018365001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice