Healthcare Provider Details

I. General information

NPI: 1639990351
Provider Name (Legal Business Name): MAZZONE DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 EASTON RD STE 2600
WARRINGTON PA
18976-2907
US

IV. Provider business mailing address

847 EASTON RD STE 2600
WARRINGTON PA
18976-2907
US

V. Phone/Fax

Practice location:
  • Phone: 215-918-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNY GARCIA-ROCHA
Title or Position: SR CREDENTIALING TEAM LEAD
Credential:
Phone: 972-869-3789