Provider Demographics
NPI:1821361809
Name:ANTHONY J. GAZZOLA, JR DMD PC
Entity Type:Organization
Organization Name:ANTHONY J. GAZZOLA, JR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GAZZOLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-884-1525
Mailing Address - Street 1:6810 POST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-2137
Mailing Address - Country:US
Mailing Address - Phone:401-884-1525
Mailing Address - Fax:401-884-9538
Practice Address - Street 1:6810 POST RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-2137
Practice Address - Country:US
Practice Address - Phone:401-884-1525
Practice Address - Fax:401-884-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty