MEDICARE: PAUL J EZZO D.D.S., PH.D

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	1223P0300X	Periodontics	17188	TX

General Provider Information

NPI Number	:	1275749442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J EZZO D.D.S., PH.D

Provider Business Mailing Address
First Line	:	2213 MCDERMOTT RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-4613
Country	:	US
Telephone Number	:	729-527-4867
Fax Number	:	972-665-1818

Provider Business Practice Location Address
First Line	:	2213 MCDERMOTT RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-4613
Country	:	US
Telephone Number	:	972-527-4867
Fax Number	:	972-665-1818

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	09/23/2022

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