MEDICARE: DR. RICHARD D'AVANZO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22DI01673500	NJ

General Provider Information

NPI Number	:	1235763343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD D'AVANZO DMD

Provider Business Mailing Address
First Line	:	14 BURNISTON CT
Second Line	:
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-2328
Country	:	US
Telephone Number	:	609-709-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 ROUTE 206
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502-4020
Country	:	US
Telephone Number	:	908-874-8360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	10/26/2025

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