Healthcare Provider Details

I. General information

NPI: 1972614527
Provider Name (Legal Business Name): DANIEL G MAZZA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 RAILROAD AVE
WINTERS CA
95694-1729
US

IV. Provider business mailing address

604 RAILROAD AVE
WINTERS CA
95694-1729
US

V. Phone/Fax

Practice location:
  • Phone: 530-795-2222
  • Fax: 530-795-2221
Mailing address:
  • Phone: 530-795-2222
  • Fax: 530-795-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: