Provider Demographics
NPI:1336369271
Name:MAZZIOTTA, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MAZZIOTTA
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 1:5415 W CEDAR LN
Mailing Address - Street 2:SUITE 206B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1515
Mailing Address - Country:US
Mailing Address - Phone:301-530-2212
Mailing Address - Fax:
Practice Address - Street 1:5415 W CEDAR LN
Practice Address - Street 2:SUITE 206B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1515
Practice Address - Country:US
Practice Address - Phone:301-530-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD86581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice