Provider Demographics
NPI:1932322435
Name:WALTER R MAZIARZ DMD PA
Entity Type:Organization
Organization Name:WALTER R MAZIARZ DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAZIARZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-224-4025
Mailing Address - Street 1:4 WALL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3740
Mailing Address - Country:US
Mailing Address - Phone:603-224-4025
Mailing Address - Fax:603-224-3960
Practice Address - Street 1:4 WALL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3740
Practice Address - Country:US
Practice Address - Phone:603-224-4025
Practice Address - Fax:603-224-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty