Provider Demographics
NPI:1316156276
Name:WILLIAM C. VIZZOLINI, D.D.S., INC.
Entity type:Organization
Organization Name:WILLIAM C. VIZZOLINI, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:VIZZOLINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-643-2660
Mailing Address - Street 1:1528 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4627
Mailing Address - Country:US
Mailing Address - Phone:707-643-2660
Mailing Address - Fax:707-643-0807
Practice Address - Street 1:1528 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4627
Practice Address - Country:US
Practice Address - Phone:707-643-2660
Practice Address - Fax:707-643-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY NUMBER