Healthcare Provider Details

I. General information

NPI: 1528262920
Provider Name (Legal Business Name): JOHN WEST BUZZA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 GUERNEVILLE RD SUITE 1200
SANTA ROSA CA
95403-4175
US

IV. Provider business mailing address

2448 GUERNEVILLE RD SUITE 1200
SANTA ROSA CA
95403-4175
US

V. Phone/Fax

Practice location:
  • Phone: 707-573-0600
  • Fax: 707-573-0690
Mailing address:
  • Phone: 707-573-0600
  • Fax: 707-573-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: