Provider Demographics
NPI:1962400309
Name:PIZZITOLA, STANLEY (DMD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:PIZZITOLA
Suffix:
Gender:M
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:PO BOX 143922
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3922
Mailing Address - Country:US
Mailing Address - Phone:939-630-0221
Mailing Address - Fax:787-815-5172
Practice Address - Street 1:1888 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2357
Practice Address - Country:US
Practice Address - Phone:860-768-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001751122300000X
CT124021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41609OtherTRIPLE SSS
PR206925OtherPREFERRED HEALTH
PR5831OtherIMC