Joseph Fazzio, DDS
Individual provider Active NPI Dentist · Ada, MI
NPI 1801372008 · NPPES record last updated Aug 4, 2021
Key facts
- NPI
- 1801372008
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901022574 (MI)
- Practice address
- 519 Ada Dr SE Ste a
Ada, MI 49301-9069 - Phone
- (616) 676-9177
- NPI assigned
- Jul 11, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| 2901022574 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norman Family Dentistry PC | Dentist | Current |
Accepting new patients |
Locations
519 Ada Dr SE
Ste A
Ada, MI 49301
Phone (616) 676-9177
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901022574 | MI | Yes |
Addresses
Primary practice location
519 Ada Dr SE Ste a
Ada, MI 49301-9069
Mailing address
519 Ada Dr SE Ste a
Ada, MI 49301-9069
Phone (616) 676-9177
Other practice location 1
465 Harbor Way
Ann Arbor, MI 48103-6666
Phone (248) 961-2991
Other providers in Ada, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2021. 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.