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General NPI Number Information
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NPI Number | 1013259910
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER J. MANDUZZI DDS PC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 7811 SUMMERS ST
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City | UTICA
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State | MI
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Zip | 48317-5559
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Country | US
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Telephone | 586-731-9240
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Fax | 586-731-4688
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Provider Business Mailing Address
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Address Line | 7811 SUMMERS ST
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City | UTICA
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State | MI
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Zip | 48317-5559
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Country | US
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Telephone | 586-731-9240
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Fax | 586-731-4688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER MANDUZZI
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Credential | D.D.S.
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Telephone | 248-227-5369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901019988
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License Number State | MI
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