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General NPI Number Information
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NPI Number | 1326537630
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Entity Type | Organization
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Legal Business Name | THOMAS MAZURANIC DDS
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 122 E MAIN ST
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City | WARRENTON
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State | MO
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Zip | 63383-2004
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Country | US
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Telephone | 636-456-4746
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Fax |
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Provider Business Mailing Address
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Address Line | 17 E GLENWOOD LN
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City | KIRKWOOD
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State | MO
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Zip | 63122-5118
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Country | US
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Telephone | 314-609-1660
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. THOMAS JOSEPH MAZURANIC
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Credential | DDS
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Telephone | 314-609-1660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2013016370
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License Number State | MO
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