Provider Demographics
NPI:1699780643
Name:PORZIO-DILIZIA, PAULETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:
Last Name:PORZIO-DILIZIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17531 SO GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2635
Mailing Address - Country:US
Mailing Address - Phone:303-278-6953
Mailing Address - Fax:303-384-0221
Practice Address - Street 1:17531 SO GOLDEN RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2635
Practice Address - Country:US
Practice Address - Phone:303-278-6953
Practice Address - Fax:303-384-0221
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05822378Medicaid