Provider Demographics
NPI:1073750402
Name:ANN E. MAZZOTTI, D.D.S.,P.C.
Entity Type:Organization
Organization Name:ANN E. MAZZOTTI, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAZZOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PC
Authorized Official - Phone:708-798-4424
Mailing Address - Street 1:18650 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3700
Mailing Address - Country:US
Mailing Address - Phone:708-798-4424
Mailing Address - Fax:708-798-7233
Practice Address - Street 1:18650 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3700
Practice Address - Country:US
Practice Address - Phone:708-798-4424
Practice Address - Fax:708-798-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0216361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty