Healthcare Provider Details

I. General information

NPI: 1699780643
Provider Name (Legal Business Name): PAULETTE PORZIO-DILIZIA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17531 SO GOLDEN RD
GOLDEN CO
80401-2635
US

IV. Provider business mailing address

17531 SO GOLDEN RD
GOLDEN CO
80401-2635
US

V. Phone/Fax

Practice location:
  • Phone: 303-278-6953
  • Fax: 303-384-0221
Mailing address:
  • Phone: 303-278-6953
  • Fax: 303-384-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7658
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: