Healthcare Provider Details

I. General information

NPI: 1265793244
Provider Name (Legal Business Name): JONILA BUZZELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JONILA PISHTARI DMD

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE STE 802
WORCESTER MA
01609-1929
US

IV. Provider business mailing address

255 PARK AVE STE 802
WORCESTER MA
01609-1929
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-9010
  • Fax:
Mailing address:
  • Phone: 508-754-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1855959
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: