Provider Demographics
NPI:1962576546
Name:BRITTEN-FAZZIO, JESSICA FAITH (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:FAITH
Last Name:BRITTEN-FAZZIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 N SWIFT RD
Mailing Address - Street 2:302
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1010
Mailing Address - Country:US
Mailing Address - Phone:630-916-8248
Mailing Address - Fax:
Practice Address - Street 1:4 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6231
Practice Address - Country:US
Practice Address - Phone:847-358-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice