Provider Demographics
NPI:1689835605
Name:AZIZ, MAZIN E (DDS)
Entity Type:Individual
Prefix:
First Name:MAZIN
Middle Name:E
Last Name:AZIZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6227
Mailing Address - Country:US
Mailing Address - Phone:919-876-2464
Mailing Address - Fax:919-876-1409
Practice Address - Street 1:4106 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6227
Practice Address - Country:US
Practice Address - Phone:919-876-2464
Practice Address - Fax:919-876-1409
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC59022452Medicaid