Provider Demographics
NPI:1497819700
Name:MAZER, KAYLA SUZANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:SUZANNE
Last Name:MAZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-348-3756
Mailing Address - Fax:203-348-8675
Practice Address - Street 1:61 FOURTH STREET
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-348-3756
Practice Address - Fax:203-348-8675
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0082831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice