MEDICARE: DR ANTHONY VIZZINIA, DMD PC

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	1223G0001X	General Practice Dentistry	4267	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942535075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ANTHONY VIZZINIA, DMD PC

Provider Business Mailing Address
First Line	:	302 4TH ST SW
Second Line	:
City	:	FT. PAYNE
State	:	AL
Zip	:	35967-1840
Country	:	US
Telephone Number	:	256-845-7300
Fax Number	:	256-845-7392

Provider Business Practice Location Address
First Line	:	302 4TH ST SW
Second Line	:
City	:	FT. PAYNE
State	:	AL
Zip	:	35967-1840
Country	:	US
Telephone Number	:	256-845-7300
Fax Number	:	256-845-7392

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY VIZZINIA
Credential	:	DMD
Telephone Number	:	256-845-7300

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	07/03/2019

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