Provider Demographics
NPI:1730265448
Name:MAZER, EDWARD MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARK
Last Name:MAZER
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 1:822 N BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2141
Mailing Address - Country:US
Mailing Address - Phone:480-730-1857
Mailing Address - Fax:
Practice Address - Street 1:6601 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3794
Practice Address - Country:US
Practice Address - Phone:480-730-1857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics