Healthcare Provider Details

I. General information

NPI: 1346828464
Provider Name (Legal Business Name): REBECCA VIZZI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EGG HARBOR RD
SEWELL NJ
08080-1856
US

IV. Provider business mailing address

340 EGG HARBOR RD
SEWELL NJ
08080-1856
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02945300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: