Basic Information
| Provider Information | |||||||||
| NPI: | 1811020241 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAZZAWI FAMILY DENTISTRY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2268 E. MAIN STREET | ||||||||
| Address2: | P. O. BOX 365 | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300780365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709724436 | ||||||||
| FaxNumber: | 7709858810 | ||||||||
| Practice Location | |||||||||
| Address1: | 2268 E. MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300780365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709724436 | ||||||||
| FaxNumber: | 7709858810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 05/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | MAZZAWI | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | MARK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7709724463 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.