Provider Demographics
NPI:1144870072
Name:FANTOZZI, REBECCA VEROSLOFF (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:VEROSLOFF
Last Name:FANTOZZI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 LITCHFIELD TPKE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1230
Mailing Address - Country:US
Mailing Address - Phone:571-508-9650
Mailing Address - Fax:
Practice Address - Street 1:435 HIGHLAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2583
Practice Address - Country:US
Practice Address - Phone:203-272-7271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12738122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist