1942535075 NPI number — DR ANTHONY VIZZINIA, DMD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942535075 NPI number — DR ANTHONY VIZZINIA, DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ANTHONY VIZZINIA, DMD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942535075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 4TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT. PAYNE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35967-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-845-7300
Provider Business Mailing Address Fax Number:
256-845-7392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 4TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. PAYNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35967-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-845-7300
Provider Business Practice Location Address Fax Number:
256-845-7392
Provider Enumeration Date:
10/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VIZZINIA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
256-845-7300

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4267 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 529911680 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com