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General NPI Number Information
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NPI Number | 1861046120
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Entity Type | Individual
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Provider Name | DAVID TRIZZINO DMD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 717 S WATER ST
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City | LOMIRA
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State | WI
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Zip | 53048-9349
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Country | US
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Telephone | 920-269-4453
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Fax |
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Provider Business Mailing Address
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Address Line | 1623 N JACKSON ST APT 308
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City | MILWAUKEE
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State | WI
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Zip | 53202-2777
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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 | 1002115-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1002115-15
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License Number State | WI
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