Provider Demographics
NPI:1275614216
Name:BENJAMIN, MAUZARD (DDS)
Entity type:Individual
Prefix:
First Name:MAUZARD
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-3002
Mailing Address - Country:US
Mailing Address - Phone:770-274-6199
Mailing Address - Fax:770-274-6144
Practice Address - Street 1:230 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3002
Practice Address - Country:US
Practice Address - Phone:770-274-6199
Practice Address - Fax:770-274-6144
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0135491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice