Provider Demographics
NPI:1013122001
Name:SCORZIELLO, THOMAS M (MS, DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:SCORZIELLO
Suffix:
Gender:M
Credentials:MS, DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HAMBURG TPKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2048
Mailing Address - Country:US
Mailing Address - Phone:973-904-1400
Mailing Address - Fax:
Practice Address - Street 1:601 HAMBURG TPKE
Practice Address - Street 2:SUITE 206
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2048
Practice Address - Country:US
Practice Address - Phone:973-904-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI179881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics