Provider Demographics
NPI:1134275795
Name:PAZ, MARIO E (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:E
Last Name:PAZ
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:4553 GLENCOE AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7918
Mailing Address - Country:US
Mailing Address - Phone:310-822-4224
Mailing Address - Fax:310-822-0569
Practice Address - Street 1:4553 GLENCOE AVE STE 330
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7918
Practice Address - Country:US
Practice Address - Phone:310-822-4224
Practice Address - Fax:310-822-0569
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA364121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics