Provider Demographics
NPI:1902919509
Name:MAZER, COREY J (DDS)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:J
Last Name:MAZER
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 1:4165 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4468
Mailing Address - Country:US
Mailing Address - Phone:678-624-0370
Mailing Address - Fax:678-624-0319
Practice Address - Street 1:4165 OLD MILTON PKWY
Practice Address - Street 2:SUITE 190
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4468
Practice Address - Country:US
Practice Address - Phone:678-624-0370
Practice Address - Fax:678-624-0319
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0122871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice