MEDICARE: MR. CHRISTOPHER DANIEL MAZZOLA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DEN9966	CO
2	1223G0001X	General Practice Dentistry	DEN-9966	CO

General Provider Information

NPI Number	:	1427285758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER DANIEL MAZZOLA D.D.S.

Provider Business Mailing Address
First Line	:	1930 S. NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-3407
Country	:	US
Telephone Number	:	719-576-5566
Fax Number	:	719-576-1100

Provider Business Practice Location Address
First Line	:	1930 S NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-3407
Country	:	US
Telephone Number	:	719-576-5566
Fax Number	:	719-576-1100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2009
Last Update Date	:	08/13/2010

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