Provider Demographics
NPI:1306115597
Name:ANNA MARIE MAZOCH, DDS, P.A.
Entity type:Organization
Organization Name:ANNA MARIE MAZOCH, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAZOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-998-9594
Mailing Address - Street 1:2601 ANNAND DRIVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-998-9594
Mailing Address - Fax:302-998-8207
Practice Address - Street 1:2601 ANNAND DR
Practice Address - Street 2:SUITE 18
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-998-9594
Practice Address - Fax:302-998-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-001096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty