Provider Demographics
NPI:1871804294
Name:MAZURETS, VIKTOR N (DDS)
Entity type:Individual
Prefix:DR
First Name:VIKTOR
Middle Name:N
Last Name:MAZURETS
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 1:12459 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2660
Mailing Address - Country:US
Mailing Address - Phone:206-242-4961
Mailing Address - Fax:206-242-7644
Practice Address - Street 1:12459 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-2660
Practice Address - Country:US
Practice Address - Phone:206-242-4961
Practice Address - Fax:206-242-7644
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60168106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist