Provider Demographics
NPI:1790996130
Name:LANDON C MAZYCK DMD PL
Entity Type:Organization
Organization Name:LANDON C MAZYCK DMD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:MAZYCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-224-4151
Mailing Address - Street 1:1001 THOMASVILLE RD # A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6293
Mailing Address - Country:US
Mailing Address - Phone:850-224-4151
Mailing Address - Fax:850-222-9192
Practice Address - Street 1:1001 THOMASVILLE RD # A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6293
Practice Address - Country:US
Practice Address - Phone:850-224-4151
Practice Address - Fax:850-222-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 10797261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental