Provider Demographics
NPI:1295190064
Name:PICO FAZZI, FRANCISCO J
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:J
Last Name:PICO FAZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 KENSEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1245
Mailing Address - Country:US
Mailing Address - Phone:610-397-1020
Mailing Address - Fax:
Practice Address - Street 1:649 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1036
Practice Address - Country:US
Practice Address - Phone:610-397-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADA027591-A1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist