Provider Demographics
NPI:1720108129
Name:STEVEN A FAZZINI DMD INC
Entity Type:Organization
Organization Name:STEVEN A FAZZINI DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAZZINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-943-1412
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:410-943-1412
Mailing Address - Fax:
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:410-943-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN018221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty