Provider Demographics
NPI:1942330212
Name:MAZIN ALAYSSAMI DMD AND ASSOC PC
Entity Type:Organization
Organization Name:MAZIN ALAYSSAMI DMD AND ASSOC PC
Other - Org Name:AMBER DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAYSSAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-620-9090
Mailing Address - Street 1:68 THOMAS JOHNSON DR STE B
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4300
Mailing Address - Country:US
Mailing Address - Phone:301-620-9090
Mailing Address - Fax:
Practice Address - Street 1:68 THOMAS JOHNSON DR STE B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4300
Practice Address - Country:US
Practice Address - Phone:301-620-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty