Provider Demographics
NPI:1508956038
Name:MAZZAWI, JOHN MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:MAZZAWI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:MAZZAWI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2645 CLAIRMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2710
Mailing Address - Country:US
Mailing Address - Phone:770-605-2520
Mailing Address - Fax:770-985-8810
Practice Address - Street 1:2268 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-972-4436
Practice Address - Fax:770-985-8810
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice