Provider Demographics
NPI:1801875836
Name:MAZOCK, JAMES B (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:MAZOCK
Suffix:
Gender:M
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:PSC 819
Mailing Address - Street 2:BOX 18-133
Mailing Address - City:FPO
Mailing Address - State:SPAIN
Mailing Address - Zip Code:AE
Mailing Address - Country:ES
Mailing Address - Phone:0113495-682-3788
Mailing Address - Fax:
Practice Address - Street 1:PSC 819
Practice Address - Street 2:BOX 18-133
Practice Address - City:FPO
Practice Address - State:SPAIN
Practice Address - Zip Code:AE
Practice Address - Country:ES
Practice Address - Phone:0113495-682-3788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery