Provider Demographics
NPI:1518162197
Name:MAZZEO, PETER M (DDS DOCTOR OF DENTAL)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:MAZZEO
Suffix:
Gender:M
Credentials:DDS DOCTOR OF DENTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 PEARL ROAD
Mailing Address - Street 2:SUITES 1 & 2
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-225-5676
Mailing Address - Fax:330-225-1567
Practice Address - Street 1:1026 PEARL ROAD
Practice Address - Street 2:SUITES 1 & 2
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:330-225-5676
Practice Address - Fax:330-225-1567
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH127081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice