The Dentists at Brinton Lake

Primary specialty

DentistTaxonomy code 122300000X

License

DSO18469L Issued in PA

Legal business name

THE DENTISTS AT BRINTON LAKE

Practice address

145 Brinton Lake Rd
Glen Mills, PA 19342

Phone

(610) 459-9963

Fax

(610) 459-9966

NPI assigned

Dec 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Charles Mazza, DDS

Title

Owner

Phone

(610) 459-9963

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1197590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197590400000",
    "number": "1205019155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 BRINTON LAKE RD",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "19342",
            "telephone_number": "610-459-9963",
            "fax_number": "610-459-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 BRINTON LAKE RD",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "19342",
            "telephone_number": "610-459-9963",
            "fax_number": "610-459-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTISTS AT BRINTON LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-14",
        "last_updated": "2007-12-14",
        "status": "A",
        "authorized_official_last_name": "MAZZA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-459-9963",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DSO18469L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharla Taliaferro, MA
• Tara Healthcare Solutions, Inc
• Jacqueline Tate
• Sharon Jessica Tatum, PT, DPT, MPT
• Arindia Taylor, LMFT
• The Nemours Foundation
• The Surgery Center at Brinton Lake, LLC
• Revathi Sangeetha Thirumaran
• David A Thomas, DO, PH.D.
• David Michael Thomas, DPT

• Dentist in Glen Mills, PA
• Providers in Glen Mills, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.