Provider Demographics
NPI:1770847964
Name:LIBRIZZI, ZACHARY T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:T
Last Name:LIBRIZZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KENNEDY DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7152
Mailing Address - Country:US
Mailing Address - Phone:802-859-9441
Mailing Address - Fax:802-862-2424
Practice Address - Street 1:1 KENNEDY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7152
Practice Address - Country:US
Practice Address - Phone:802-859-9441
Practice Address - Fax:802-862-2424
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VT016.01067611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1025018Medicaid