Provider Demographics
NPI:1982854139
Name:FAZZINI, STEVEN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:FAZZINI
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 1:2000 CHAPEL VIEW BLVD
Mailing Address - Street 2:SUITE #370
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-3078
Mailing Address - Country:US
Mailing Address - Phone:401-943-1412
Mailing Address - Fax:401-943-2032
Practice Address - Street 1:2000 CHAPEL VIEW BLVD
Practice Address - Street 2:SUITE #370
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-3078
Practice Address - Country:US
Practice Address - Phone:401-943-1412
Practice Address - Fax:401-943-2032
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN018221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice