Provider Demographics
NPI:1376542498
Name:IZZO, CARLO (DDS)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:IZZO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1755
Mailing Address - Country:US
Mailing Address - Phone:516-887-1199
Mailing Address - Fax:516-887-4043
Practice Address - Street 1:144 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1755
Practice Address - Country:US
Practice Address - Phone:516-887-1199
Practice Address - Fax:516-887-1199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NY0452341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist