Gerald A Brazzo, DMD
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Hazleton, PA
NPI 1215072863 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215072863
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- DS015043L (PA)
- Practice address
- 255 West Diamond Ave
Hazleton, PA 18201 - Phone
- (570) 454-0783
- Fax
- (570) 454-4609
- NPI assigned
- Feb 21, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS015043L | PA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DS015043L | PA | Yes |
Addresses
Primary practice location
255 West Diamond Ave
Hazleton, PA 18201
Mailing address
255 West Diamond Ave
Hazleton, PA 18201
Phone (570) 454-0783
Other providers in Hazleton, PA
- Janice Mary Bonner
- Theresa Ann Boyle
- Christina M Bradford
- Jeremy Alan Bragalone
- Avrene Laura Brandt
- John Brennan
- Daniel John Breznak
- Jason Clair Brown
- Harry Bruley
- Pamela Brune
All providers in Hazleton, PA · Orthodontics and Dentofacial Orthopedics Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.