Individual provider · Type 1 NPI
Justin Riece Fazzolari, DMD, MD
Oral and Maxillofacial Surgery (Dentist) · New York, NY
NPI number
1295296168
Active
Practice location
200 W 57th St Ste 804
New York, NY 10019-3217
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 22DI03028700 (NJ) |
| Oral and Maxillofacial Surgery (Dentist) Primary | 1223S0112X | 065003 (NY) |
Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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About NPI 1295296168
Justin Riece Fazzolari, DMD, MD's National Provider Identifier is 1295296168, issued on Mar 25, 2019. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in New York, NY. The record was last updated on Aug 19, 2025.