Provider Demographics
NPI:1659462265
Name:GIANNUZZI, NICHOLAS J (DDS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:GIANNUZZI
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 1:10 HUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2714
Mailing Address - Country:US
Mailing Address - Phone:631-821-3838
Mailing Address - Fax:
Practice Address - Street 1:10 HUNTER AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2714
Practice Address - Country:US
Practice Address - Phone:631-821-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0422401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice