Healthcare Provider Details

I. General information

NPI: 1295872190
Provider Name (Legal Business Name): LEANNE MAZZEI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9387 W SAMPLE RD
CORAL SPRINGS FL
33065-4101
US

IV. Provider business mailing address

7301A W PALMETTO PARK RD SUITE 104C
BOCA RATON FL
33433-3409
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-5040
  • Fax: 954-345-5394
Mailing address:
  • Phone: 561-391-5126
  • Fax: 561-391-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN0013983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: