Walter Matthew Mazzella, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12129 Issued in MD

Practice address

10775 Birmingham Way
Suite 1
Woodstock, MD 21163-1425

Phone

(410) 203-2552

NPI assigned

Dec 31, 2012

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 2, 2015 through Sep 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walter M. Mazzella, D.D.S., P.C.

  • General Practice Dentistry
  • Woodstock, MD
  • NPI 1881787513
  NPD (past) Authorized official

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

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356912000000",
    "number": "1487990099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10775 BIRMINGHAM WAY",
            "address_2": "SUITE 1",
            "city": "WOODSTOCK",
            "state": "MD",
            "postal_code": "211631425",
            "telephone_number": "410-203-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10775 BIRMINGHAM WAY",
            "address_2": "SUITE 1",
            "city": "WOODSTOCK",
            "state": "MD",
            "postal_code": "211631425",
            "telephone_number": "410-203-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZELLA",
        "first_name": "WALTER",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-31",
        "last_updated": "2012-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "12129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliza Nina Lobo, PT
• Anne J Loovis, L.C.P.C.
• Alicja Mannel
• Jennifer Manning Plassnig, LCSW-C
• Lori Kay Mannino, LCSW-C
• Michelle Morrison and Associates
• Monarch Wellness and Counseling Services
• Michelle Marie Morrison
• Robert William Nagle
• Susan Ouellette, APRN

• Dentist in Woodstock, MD
• Providers in Woodstock, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.