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General NPI Number Information
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NPI Number | 1497189476
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Entity Type | Individual
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Provider Name | MICHAEL CAREY DEFAZIO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 8955 WOOD RD
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City | BETHESDA
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State | MD
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Zip | 20889-5628
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Country | US
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Telephone | 301-295-4023
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 100222 BOX 1
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City | FPO
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State | AP
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Zip | 96672-2200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019029664
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License Number State | IL
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