Provider Demographics
NPI:1710388582
Name:PEZZELLA, SALVATORE ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:ROBERT
Last Name:PEZZELLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6332
Mailing Address - Country:US
Mailing Address - Phone:727-381-7888
Mailing Address - Fax:
Practice Address - Street 1:901 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6332
Practice Address - Country:US
Practice Address - Phone:727-381-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist