Provider Demographics
NPI:1518649920
Name:RAYMOND MAZUCHOWSKI DDS
Entity Type:Organization
Organization Name:RAYMOND MAZUCHOWSKI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZUCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-735-3897
Mailing Address - Street 1:3915 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1017
Mailing Address - Country:US
Mailing Address - Phone:715-735-3897
Mailing Address - Fax:715-735-3898
Practice Address - Street 1:3915 HALL AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1017
Practice Address - Country:US
Practice Address - Phone:715-735-3897
Practice Address - Fax:715-735-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental