MEDICARE: DR. SCOTT ANDREW MAZANEC DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-01-8081	OH

General Provider Information

NPI Number	:	1063415917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT ANDREW MAZANEC DDS

Provider Business Mailing Address
First Line	:	709 HOSPITAL LOOP STE 118
Second Line	:
City	:	FAIRCHILD AFB
State	:	WA
Zip	:	99011-8705
Country	:	US
Telephone Number	:	509-465-0995
Fax Number	:	509-247-4140

Provider Business Practice Location Address
First Line	:	709 HOSPITAL LOOP STE 118
Second Line	:
City	:	FAIRCHILD AFB
State	:	WA
Zip	:	99011-8705
Country	:	US
Telephone Number	:	509-465-0995
Fax Number	:	509-247-4140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/09/2007

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