Provider Demographics
NPI:1609961861
Name:MAZZOCCO, DANIEL MICHAEL JR (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:MAZZOCCO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:305 SOUTH CHURCH STREET
Mailing Address - Street 2:SOUTH GATE OFFICE COMPLEX SUITE 190
Mailing Address - City:HAZELTON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7605
Mailing Address - Country:US
Mailing Address - Phone:570-459-2526
Mailing Address - Fax:570-455-8369
Practice Address - Street 1:305 SOUTH CHURCH STREET
Practice Address - Street 2:SOUTH GATE OFFICE COMPLEX SUITE 190
Practice Address - City:HAZELTON
Practice Address - State:PA
Practice Address - Zip Code:18201-7605
Practice Address - Country:US
Practice Address - Phone:570-459-2526
Practice Address - Fax:570-455-8369
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018626L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics