Provider Demographics
NPI:1336206630
Name:MAZER-GURMENDI, RAQUEL B (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:B
Last Name:MAZER-GURMENDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 COLONY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5557
Mailing Address - Country:US
Mailing Address - Phone:205-934-1022
Mailing Address - Fax:205-975-2883
Practice Address - Street 1:1919 7TH AVE S
Practice Address - Street 2:SDB-BOX 82
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0007
Practice Address - Country:US
Practice Address - Phone:205-934-2340
Practice Address - Fax:205-934-7899
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice