Individual
JOSEPH J FANTUZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S, M.D.
Contact information
Practice address
601 ELMWOOD AVE, BOX 705, ROCHESTER, NY 14642-0001
(585) 275-5084
(585) 276-0293
Mailing address
601 ELMWOOD AVE, BOX 705, ROCHESTER, NY 14642-0001
(585) 275-5084
(585) 276-0293
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
043604
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02636886
—
NY
01
—
MDJ123
PREFERRED CARE
—
Enumeration date
08/23/2006
Last updated
07/08/2007
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