Healthcare Provider Details

I. General information

NPI: 1780691337
Provider Name (Legal Business Name): GERARD ROBERT NAZZIOLA JR. DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. GERARD R NAZZIOLA

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 A ADAMS FARM LANE
GREENSBORO NC
27407-7098
US

IV. Provider business mailing address

5501 A ADAMS FARM LANE
GREENSBORO NC
27407-7098
US

V. Phone/Fax

Practice location:
  • Phone: 336-851-9232
  • Fax: 336-851-9236
Mailing address:
  • Phone: 336-851-9232
  • Fax: 336-851-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: