Provider Demographics
NPI:1477575371
Name:SCALZITTI, CORINNE ROSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:ROSE
Last Name:SCALZITTI
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 1:3900 RANCH ROAD 620 S
Mailing Address - Street 2:SUITE 106
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6300
Mailing Address - Country:US
Mailing Address - Phone:512-263-3330
Mailing Address - Fax:512-263-9771
Practice Address - Street 1:3900 RANCH ROAD 620 S
Practice Address - Street 2:SUITE 106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6300
Practice Address - Country:US
Practice Address - Phone:512-263-3330
Practice Address - Fax:512-263-9771
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11,590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist