Provider Demographics
NPI:1457799678
Name:MAZYCK, LANDON CAMERON (DMD)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:CAMERON
Last Name:MAZYCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 THOMASVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6293
Mailing Address - Country:US
Mailing Address - Phone:850-224-4151
Mailing Address - Fax:850-222-9192
Practice Address - Street 1:1001 THOMASVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6293
Practice Address - Country:US
Practice Address - Phone:850-224-4151
Practice Address - Fax:850-222-9192
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 107971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice