=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609918101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD A PIZZI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 09/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13983 MANGO DR SUITE 201
-----------------------------------------------------
City | DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92014-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-755-0187
-----------------------------------------------------
Fax | 858-755-0387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13983 MANGO DR SUITE 201
-----------------------------------------------------
City | DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92014-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-755-0187
-----------------------------------------------------
Fax | 858-755-0387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19967
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 64667
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------