Provider Demographics
NPI:1427416049
Name:MAZUR, SUSAN MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIA
Last Name:MAZUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2146 LIVERNOIS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1636
Mailing Address - Country:US
Mailing Address - Phone:248-730-1070
Mailing Address - Fax:
Practice Address - Street 1:2146 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1636
Practice Address - Country:US
Practice Address - Phone:248-730-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist