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General NPI Number Information
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NPI Number | 1396511291
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Entity Type | Individual
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Provider Name | JOHN MAZZOCCO DDS
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Gender | Male
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Dates
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Enumeration Date | 11/30/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 1011 N UNIVERSITY AVE
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City | ANN ARBOR
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State | MI
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Zip | 48109-1078
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Country | US
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Telephone | 630-362-2986
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Fax |
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Provider Business Mailing Address
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Address Line | 522 N DIVISION ST APT 4
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City | ANN ARBOR
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State | MI
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Zip | 48104-1185
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Country | US
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Telephone | 630-362-2986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2901601580
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License Number State | MI
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