Provider Demographics
NPI:1407497688
Name:GAZU, ANNA MS (DMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MS
Last Name:GAZU
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 1:1159 GREENWOOD LAKE TPKE
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1403
Mailing Address - Country:US
Mailing Address - Phone:973-728-5115
Mailing Address - Fax:973-728-8869
Practice Address - Street 1:1159 GREENWOOD LAKE TPKE
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-1403
Practice Address - Country:US
Practice Address - Phone:973-728-5115
Practice Address - Fax:973-728-8869
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102772600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist