Provider Demographics
NPI:1871877365
Name:VINCENT M. MAZUREK, DDS, PC
Entity type:Organization
Organization Name:VINCENT M. MAZUREK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAZUREK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-543-0550
Mailing Address - Street 1:823 W JERICHO TPKE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3216
Mailing Address - Country:US
Mailing Address - Phone:631-543-0550
Mailing Address - Fax:
Practice Address - Street 1:823 W JERICHO TPKE
Practice Address - Street 2:SUITE 1B
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3216
Practice Address - Country:US
Practice Address - Phone:631-543-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035995-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty