Healthcare Provider Details

I. General information

NPI: 1225026453
Provider Name (Legal Business Name): JOHN E. BUZZELLI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11406 CLIFTON BLVD
CLEVELAND OH
44102-1455
US

IV. Provider business mailing address

11406 CLIFTON BLVD
CLEVELAND OH
44102-1455
US

V. Phone/Fax

Practice location:
  • Phone: 216-962-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14925
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: