MEDICARE: MAZIN ALAYSSAMI, DMD AND ASSOCIATES, PA

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	22D102468000	NJ

General Provider Information

NPI Number	:	1275691396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAZIN ALAYSSAMI, DMD AND ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	526 S BURNT MILL RD
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2205
Country	:	US
Telephone Number	:	856-795-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 S BURNT MILL RD
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2205
Country	:	US
Telephone Number	:	856-795-5565
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAZIN ALAYSSAMI
Credential	:	D.M.D
Telephone Number	:	856-795-5565

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	05/03/2011

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