Provider Demographics
NPI:1780691337
Name:NAZZIOLA, GERARD ROBERT JR (DDS MS)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:ROBERT
Last Name:NAZZIOLA
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:DR
Other - First Name:GERARD
Other - Middle Name:R
Other - Last Name:NAZZIOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5501 A ADAMS FARM LANE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7098
Mailing Address - Country:US
Mailing Address - Phone:336-851-9232
Mailing Address - Fax:336-851-9236
Practice Address - Street 1:5501 A ADAMS FARM LANE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7098
Practice Address - Country:US
Practice Address - Phone:336-851-9232
Practice Address - Fax:336-851-9236
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics