Basic Information
| Provider Information | |||||||||
| NPI: | 1962400309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIZZITOLA | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 143922 | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006143922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9396300221 | ||||||||
| FaxNumber: | 7878155172 | ||||||||
| Practice Location | |||||||||
| Address1: | 1888 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061202357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607689052 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 001751 | PR | N | Dental Providers | Dentist | 1223G0001X | 12402 | CT | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 41609 | 01 | PR | TRIPLE SSS | OTHER | 206925 | 01 | PR | PREFERRED HEALTH | OTHER | 5831 | 01 | PR | IMC | OTHER |