Provider Demographics
NPI:1306993779
Name:MAZZUCA, RALPH THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:THOMAS
Last Name:MAZZUCA
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 1:5100 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 406
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4131
Mailing Address - Country:US
Mailing Address - Phone:202-537-1088
Mailing Address - Fax:202-537-0994
Practice Address - Street 1:5100 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 406
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4131
Practice Address - Country:US
Practice Address - Phone:202-537-1088
Practice Address - Fax:202-537-0994
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN2416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist