Provider Demographics
NPI:1093822470
Name:JOHN E. MAZZA DDS, INC.
Entity Type:Organization
Organization Name:JOHN E. MAZZA DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-641-5200
Mailing Address - Street 1:2480 MISSION ST
Mailing Address - Street 2:SUITE #220
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2468
Mailing Address - Country:US
Mailing Address - Phone:415-641-5200
Mailing Address - Fax:415-641-7004
Practice Address - Street 1:2480 MISSION ST
Practice Address - Street 2:SUITE #220
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2468
Practice Address - Country:US
Practice Address - Phone:415-641-5200
Practice Address - Fax:415-641-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty