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NPI Code Detail

MEDICARE: NICHOLAS BIZZARO DMD

MEDICARE: NICHOLAS BIZZARO 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
11223G0001XGeneral Practice DentistryDS042438PA

General Provider Information

NPI Number : 1366090094
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS BIZZARO DMD
Provider Business Mailing Address
First Line : 5639 RIDGE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-2765
Country : US
Telephone Number : 215-896-6524
Fax Number :
Provider Business Practice Location Address
First Line : 3223 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-5007
Country : US
Telephone Number : 215-707-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2019
Last Update Date : 05/06/2026

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Directions to “ NICHOLAS BIZZARO DMD” Practice Location

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