Provider Demographics
NPI:1265793244
Name:BUZZELL, JONILA (DMD)
Entity type:Individual
Prefix:DR
First Name:JONILA
Middle Name:
Last Name:BUZZELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505
Mailing Address - Country:US
Mailing Address - Phone:508-869-6388
Mailing Address - Fax:
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1948
Practice Address - Country:US
Practice Address - Phone:508-869-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18559591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice