MEDICARE: DR. MAZEN ALMASHLI BDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DTP753	FL

General Provider Information

NPI Number	:	1265185268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAZEN ALMASHLI BDS

Provider Business Mailing Address
First Line	:	2800 UNIVERSITY BLVD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3321
Country	:	US
Telephone Number	:	904-256-7846
Fax Number	:	904-256-7798

Provider Business Practice Location Address
First Line	:	5491 DOLPHIN POINTE BOULEVARD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3221
Country	:	US
Telephone Number	:	904-256-7846
Fax Number	:	904-256-7798

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

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	01/31/2022

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