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General NPI Number Information
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NPI Number | 1811020241
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Entity Type | Organization
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Legal Business Name | MAZZAWI FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 2268 E. MAIN ST
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City | SNELLVILLE
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State | GA
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Zip | 30078-0365
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Country | US
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Telephone | 770-972-4436
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Fax | 770-985-8810
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Provider Business Mailing Address
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Address Line | 2268 E. MAIN STREET P. O. BOX 365
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City | SNELLVILLE
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State | GA
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Zip | 30078-0365
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Country | US
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Telephone | 770-972-4436
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Fax | 770-985-8810
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN MARK MAZZAWI
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Credential | DMD
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Telephone | 770-972-4463
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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 |
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License Number State | GA
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