Provider Demographics
NPI:1861579435
Name:MOCZYGEMBA, JOHN B (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:MOCZYGEMBA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1309 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3427
Mailing Address - Country:US
Mailing Address - Phone:830-625-4515
Mailing Address - Fax:830-625-4515
Practice Address - Street 1:162 SOUTH SEGUIN AVENUE
Practice Address - Street 2:
Practice Address - City:NEW BRANFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-625-4515
Practice Address - Fax:830-625-4515
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist