Provider Demographics
NPI:1669098208
Name:DR. JOSEPH M. MAZUREK, INC
Entity type:Organization
Organization Name:DR. JOSEPH M. MAZUREK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAZUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-568-4733
Mailing Address - Street 1:6500 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4732
Mailing Address - Country:US
Mailing Address - Phone:501-568-4733
Mailing Address - Fax:501-568-4700
Practice Address - Street 1:6500 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4732
Practice Address - Country:US
Practice Address - Phone:501-568-4733
Practice Address - Fax:501-568-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112152608Medicaid