Healthcare Provider Details

I. General information

NPI: 1528767852
Provider Name (Legal Business Name): JUSTINE M INZERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CHURCH HILL RD STE 2
NEWTOWN CT
06470-1612
US

IV. Provider business mailing address

27 CHURCH HILL RD STE 2
NEWTOWN CT
06470-1612
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-3310
  • Fax:
Mailing address:
  • Phone: 203-426-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number14500
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: