MEDICARE: DR. GERARD ROBERT NAZZIOLA JR. DDS MS

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	6161	NC

General Provider Information

NPI Number	:	1780691337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD ROBERT NAZZIOLA JR. DDS MS

Provider Business Mailing Address
First Line	:	5501 A ADAMS FARM LANE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-7098
Country	:	US
Telephone Number	:	336-851-9232
Fax Number	:	336-851-9236

Provider Business Practice Location Address
First Line	:	5501 A ADAMS FARM LANE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-7098
Country	:	US
Telephone Number	:	336-851-9232
Fax Number	:	336-851-9236

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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