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Provider Information for 1760541841



DR. THOMAS J MAZZUCKELLI PHD, DMD

Gender: MALE

Individual NPI: 1760541841

Calendar   Last Updated:  2009-10-28
  Certification Date: 

Details

Name Value
NPI 1760541841
Enumeration Date 2006-12-06
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 11255 PARSONS RD SUITE 100
DULUTH, GA 30097-1703
United States

Phone: 770-569-1350 | Fax: 770-569-1392
View Map External Link
Primary Practice Address 11255 PARSONS RD SUITE 100
DULUTH, GA 30097-1703
United States

Phone: 770-569-1350 | Fax: 770-569-1392
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice GA DNO 11417