Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Justin Riece Fazzolari, DMD, MD

Individual provider Oral and Maxillofacial Surgery (Dentist) · NPI 1295296168

Justin Riece Fazzolari, DMD, MD is an Oral and Maxillofacial Surgery (Dentist) in New York, New York. Licensed in New Jersey and New York. Registered with an NPI since 2019.

Licensed in
NJ, NY
In the registry since
2019
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

200 W 57th St Ste 804
New York, NY 10019-3217
Phone: (646) 895-9680
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 065003 (NY)
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X · Licence 22DI03028700 (NJ)

Record details

NPI number1295296168
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD , MD
Sole proprietorNo
NPI enumeratedMarch 25, 2019
Last updated in NPPESAugust 19, 2025
Certification dateAugust 19, 2025

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