Provider Demographics
NPI:1548311277
Name:MAZOCH, ANNA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:MAZOCH
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 1:2601 ANNAND DR
Mailing Address - Street 2:SUITE 18
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-998-9594
Mailing Address - Fax:302-998-8207
Practice Address - Street 1:2601 ANNAND DR
Practice Address - Street 2:SUITE 18
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3719
Practice Address - Country:US
Practice Address - Phone:302-998-9594
Practice Address - Fax:302-998-8207
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2001109028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist