Individual
DR. ANTHONY WILLIAM FAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2600 ROUTE 112, MEDFORD, NY 11763
(631) 475-3345
(631) 475-1090
Mailing address
111 SPRUCE DR, HOLBROOK, NY 11741
(631) 207-1334
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0472071
NY
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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