Provider Demographics
NPI:1235508078
Name:JOSEPH D MAZZOLA DDS
Entity Type:Organization
Organization Name:JOSEPH D MAZZOLA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAZZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MAGD
Authorized Official - Phone:303-466-9533
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:80023-3604
Mailing Address - Country:US
Mailing Address - Phone:303-466-9533
Mailing Address - Fax:303-466-2786
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:80023-3604
Practice Address - Country:US
Practice Address - Phone:303-466-9533
Practice Address - Fax:303-466-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty