Provider Demographics
NPI:1093932063
Name:MAZZOLA, JOSEPH D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:MAZZOLA
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 1:13606 XAVIER LN STE G
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3604
Mailing Address - Country:US
Mailing Address - Phone:303-466-9533
Mailing Address - Fax:909-466-2786
Practice Address - Street 1:13606 XAVIER LN STE G
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3604
Practice Address - Country:US
Practice Address - Phone:303-466-9533
Practice Address - Fax:909-466-2786
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1054371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice