MEDICARE: VINEYARDS DENTAL CARE

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	DNO 14417	GA

General Provider Information

NPI Number	:	1225191935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINEYARDS DENTAL CARE

Provider Business Mailing Address
First Line	:	2095 HIGHWAY 211 NW
Second Line	:	SUITE 6-A
City	:	BRASELTON
State	:	GA
Zip	:	30517-3402
Country	:	US
Telephone Number	:	770-868-4288
Fax Number	:	770-868-4291

Provider Business Practice Location Address
First Line	:	2095 HIGHWAY 211 NW
Second Line	:	SUITE 6-A
City	:	BRASELTON
State	:	GA
Zip	:	30517-3402
Country	:	US
Telephone Number	:	770-868-4288
Fax Number	:	770-868-4291

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS J. MAZZUCKELLI
Credential	:	PHD., D.M.D.
Telephone Number	:	770-868-4288

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1669536082 — CHATEAU SPINAL REHAB
Practice Location Address:

2095 HIGHWAY 211 NW , SUITE 3A
BRASELTON, GA
30517-3402

Practice Phone: 770-307-0968
Practice Fax: 770-868-0598

1518001957 — DR. ILISA BETH STERN DMD
Practice Location Address:

2095 HIGHWAY 211 NW , SUITE 6A
BRASELTON, GA
30517-3402

Practice Phone: 770-868-4288
Practice Fax:

1396958450 — FREDERICA KENNEDY OTR/L, OTD
Practice Location Address:

2095 HIGHWAY 211 NW STE D
BRASELTON, GA
30517-3402

Practice Phone: 770-207-6390
Practice Fax: 678-374-4855

1336492982 — GARY R. ADAMS DC
Practice Location Address:

2095 HIGHWAY 211 NW , STE 2-F, PMB #105
BRASELTON, GA
30517-3402

Practice Phone: 770-307-0968
Practice Fax: 770-868-0598

1518204569 — MR. DANIEL E AULT RPH
Practice Location Address:

2095 HIGHWAY 211 NW
BRASELTON, GA
30517-3402

Practice Phone: 678-425-6206
Practice Fax: 678-425-6211

1275087462 — CARMEN WAUGH CSA
Practice Location Address:

2095 HIGHWAY 211 NW # 147-2F
BRASELTON, GA
30517-3402

Practice Phone: 678-789-3057
Practice Fax:

Directions to “VINEYARDS DENTAL CARE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.