Healthcare Provider Details

I. General information

NPI: 1962400309
Provider Name (Legal Business Name): STANLEY PIZZITOLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 MAIN ST
HARTFORD CT
06120-2357
US

IV. Provider business mailing address

PO BOX 143922
ARECIBO PR
00614-3922
US

V. Phone/Fax

Practice location:
  • Phone: 860-768-9052
  • Fax:
Mailing address:
  • Phone: 939-630-0221
  • Fax: 787-815-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number001751
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12402
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: