Provider Demographics
NPI:1124482922
Name:MAZZEI ORTHODONTICS
Entity type:Organization
Organization Name:MAZZEI ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-752-5040
Mailing Address - Street 1:9387 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4101
Mailing Address - Country:US
Mailing Address - Phone:954-752-5040
Mailing Address - Fax:954-345-5394
Practice Address - Street 1:9387 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4101
Practice Address - Country:US
Practice Address - Phone:954-752-5040
Practice Address - Fax:954-345-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3992261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1295872190OtherNPI