Provider Demographics
NPI:1275689119
Name:PEZZOLESI, DENNIS KARL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KARL
Last Name:PEZZOLESI
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:213 SCARBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7546
Mailing Address - Country:US
Mailing Address - Phone:860-346-1473
Mailing Address - Fax:860-828-1610
Practice Address - Street 1:39 WEBSTER SQUARE RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-2326
Practice Address - Country:US
Practice Address - Phone:860-828-3933
Practice Address - Fax:860-828-1610
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0072471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice