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DR. WALTER MATTHEW MAZZELLA DDS
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1487990099
Individual Registrant:DR. WALTER MATTHEW MAZZELLA DDS
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
10775 BIRMINGHAM WAY SUITE 1 WOODSTOCK, MD 21163-1425 US
Tel: 410-203-2552 Fax: --
Tel: 410-203-2552 Fax: --
Contact information for business:
10775 BIRMINGHAM WAY SUITE 1 WOODSTOCK, MD 21163-1425 US
Tel: 410-203-2552 Fax: --
Tel: 410-203-2552 Fax: --
Registration Information:
NPI: 1487990099
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | MD | 12129 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
