Healthcare Provider Details

I. General information

NPI: 1295862845
Provider Name (Legal Business Name): MARK D HUZYAK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL A-260
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

741 FRONT ST #330
CELEBRATION FL
34747-4991
US

V. Phone/Fax

Practice location:
  • Phone: 407-566-2222
  • Fax: 407-566-1650
Mailing address:
  • Phone: 407-566-2222
  • Fax: 407-566-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN0010531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: