Provider Demographics
NPI:1821021833
Name:MAZIN, LAURENCE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:J
Last Name:MAZIN
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 1:8080 OLD YORK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1426
Mailing Address - Country:US
Mailing Address - Phone:215-884-7077
Mailing Address - Fax:
Practice Address - Street 1:8080 OLD YORK RD STE 205
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1426
Practice Address - Country:US
Practice Address - Phone:215-884-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027020L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA697708OtherUNITED CONCORDIA