Provider Demographics
NPI:1528767852
Name:INZERO, JUSTINE M
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:INZERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CHURCH HILL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1612
Mailing Address - Country:US
Mailing Address - Phone:203-426-3310
Mailing Address - Fax:
Practice Address - Street 1:27 CHURCH HILL RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1612
Practice Address - Country:US
Practice Address - Phone:203-426-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT145001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program