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General NPI Number Information
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NPI Number | 1386373744
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Entity Type | Organization
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Legal Business Name | JEREMY M BEZZO DDS PC
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 45 ELM ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-5903
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Country | US
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Telephone | 734-281-2710
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Fax | 734-281-8836
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Provider Business Mailing Address
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Address Line | 45 ELM ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-5903
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Country | US
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Telephone | 734-281-2710
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Fax | 734-281-8836
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEREMY M BEZZO
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Credential |
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Telephone | 734-281-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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