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NPI Code Detail

MEDICARE: DR. EDWARD CRAIG MAZIQUE II D.D.S.

MEDICARE: DR. EDWARD CRAIG MAZIQUE II D.D.S.
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry15695MD

General Provider Information

NPI Number : 1669899621
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD CRAIG MAZIQUE II D.D.S.
Provider Business Mailing Address
First Line : 350 N CLARK ST
Second Line : 6TH FLOOR
City : CHICAGO
State : IL
Zip : 60654-4712
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3925 MINNESOTA AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-2662
Country : US
Telephone Number : 202-396-1444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2014
Last Update Date : 05/23/2016

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