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General NPI Number Information
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NPI Number | 1740394550
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Entity Type | Organization
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Legal Business Name | DRS. ROSSETTI & FANNO, INC.
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4811 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-3614
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Country | US
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Telephone | 330-494-4580
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Fax | 330-494-6230
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Provider Business Mailing Address
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Address Line | 4811 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-3614
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Country | US
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Telephone | 330-494-4580
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Fax | 330-494-6230
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Authorized Official
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Title or Position | ORTHODONTIST / SECRETARY/TREASURER
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Name | DR. JAMES T FANNO
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Credential | D.M.D., M.S.
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Telephone | 330-494-4580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12322
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12861
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License Number State | OH
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