Provider Demographics
NPI:1679784987
Name:JANNUZZI, JEREMY R (DMD, MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:JANNUZZI
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 INVERNESS DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5137
Mailing Address - Country:US
Mailing Address - Phone:303-773-8228
Mailing Address - Fax:303-773-0142
Practice Address - Street 1:125 INVERNESS DR E
Practice Address - Street 2:SUITE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5137
Practice Address - Country:US
Practice Address - Phone:303-773-8228
Practice Address - Fax:303-773-0142
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist