Provider Demographics
NPI:1083967947
Name:MAZIKAS, CAROLYN BARCLAY
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:BARCLAY
Last Name:MAZIKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:BARCLAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:660 KENILWORTH DR
Mailing Address - Street 2:#205
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2354
Mailing Address - Country:US
Mailing Address - Phone:410-823-1005
Mailing Address - Fax:410-825-2219
Practice Address - Street 1:660 KENILWORTH DR
Practice Address - Street 2:#205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2354
Practice Address - Country:US
Practice Address - Phone:410-823-1005
Practice Address - Fax:410-825-2219
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist