Provider Demographics
NPI:1821142100
Name:MAZUR, CHRISTIAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:J
Last Name:MAZUR
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 1:821 TWYCKENHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-6760
Mailing Address - Country:US
Mailing Address - Phone:765-477-0331
Mailing Address - Fax:765-477-1620
Practice Address - Street 1:821 TWYCKENHAM BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-6760
Practice Address - Country:US
Practice Address - Phone:765-477-0331
Practice Address - Fax:765-477-1620
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010269A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice