Provider Demographics
NPI:1316194442
Name:GAZZILLO, DEBORAH (DDS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GAZZILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COLONY LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4721
Mailing Address - Country:US
Mailing Address - Phone:516-682-8013
Mailing Address - Fax:
Practice Address - Street 1:160 COMMACK RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3412
Practice Address - Country:US
Practice Address - Phone:631-499-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046119-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist