Thomas John Mazzuchelli, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012065 Issued in GA

Practice address

58 Shawnee LN
Marietta, GA 30067-7316

Phone

(770) 973-6520

NPI assigned

Mar 25, 2008

Last updated

Mar 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206403200000",
    "number": "1003088592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 SHAWNEE LN",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300677316",
            "telephone_number": "770-973-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 SHAWNEE LN",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300677316",
            "telephone_number": "770-973-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZUCHELLI",
        "first_name": "THOMAS",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Tyler Mayotte, PHARM. D.
• Kenisha Mays
• Nitin N Mayur, MD
• Janusz Mazon, D.C.
• Brianna Mazzei, OT, OTD
• MBC Care Agency, LLC
• MBS Wellness Group, LLC
• Brenda N Mburu
• Samuel Mburu
• Allie McAllister, NP-C

• General Practice Dentistry in Marietta, GA
• Providers in Marietta, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.