Individual
DR. JASON ROGER IZZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1351 SMITH ST, NORTH PROVIDENCE, RI 02911-3340
(401) 353-2045
(401) 354-8488
Mailing address
1351 SMITH ST, NORTH PROVIDENCE, RI 02911-3340
(401) 353-2045
(401) 354-8488
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2581
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8761-8
BLUE CROSS
RI
05
—
JI27223
—
RI
Enumeration date
07/25/2006
Last updated
07/09/2007
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