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General NPI Number Information
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NPI Number | 1518649920
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Entity Type | Organization
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Legal Business Name | RAYMOND MAZUCHOWSKI DDS
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 3915 HALL AVE
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City | MARINETTE
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State | WI
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Zip | 54143-1017
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Country | US
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Telephone | 715-735-3897
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Fax | 715-735-3898
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Provider Business Mailing Address
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Address Line | 3915 HALL AVE
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City | MARINETTE
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State | WI
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Zip | 54143-1017
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Country | US
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Telephone | 715-735-3897
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Fax | 715-735-3898
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RAYMOND MAZUCHOWSKI
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Credential | D.D.S.
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Telephone | 715-735-3897
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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 |
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License Number State |
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