Individual
DR. MICHAEL FAZZONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
530 SOUTH WAKARA WAY, UNIVERSITY OF URAH, SCHOOL OF DENTISTRY, SALT LAKE CITY, UT 84108
(801) 581-8951
Mailing address
35 COMELY LN, LATHAM, NY 12110-5230
(518) 281-0663
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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