Healthcare Provider Details

I. General information

NPI: 1235221193
Provider Name (Legal Business Name): CHRISTOPHER JOHN MOZRALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2674 CHILI AVE
ROCHESTER NY
14624-4154
US

IV. Provider business mailing address

2674 CHILI AVE
ROCHESTER NY
14624-4154
US

V. Phone/Fax

Practice location:
  • Phone: 585-247-6018
  • Fax: 585-247-8521
Mailing address:
  • Phone: 585-247-6018
  • Fax: 585-247-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number045769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: