Provider Demographics
NPI:1598221673
Name:GHIVIZZANI, MEREDITH MURRAY (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:MURRAY
Last Name:GHIVIZZANI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7375 E 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8194
Mailing Address - Country:US
Mailing Address - Phone:352-281-4047
Mailing Address - Fax:
Practice Address - Street 1:7375 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-8194
Practice Address - Country:US
Practice Address - Phone:720-629-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349251223P0221X
FLDN231391223P0221X
CODEN.002042031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty