Thomas J Mazzuckelli, PHD, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DNO 11417 Issued in GA

Practice address

11255 Parsons Rd
Suite 100
Duluth, GA 30097-1703

Phone

(770) 569-1350

Fax

(770) 569-1392

NPI assigned

Dec 6, 2006

Last updated

Oct 28, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256688000000",
    "number": "1760541841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11255 PARSONS RD",
            "address_2": "SUITE 100",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300971703",
            "telephone_number": "770-569-1350",
            "fax_number": "770-569-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11255 PARSONS RD",
            "address_2": "SUITE 100",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300971703",
            "telephone_number": "770-569-1350",
            "fax_number": "770-569-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZUCKELLI",
        "first_name": "THOMAS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PHD, DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2009-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DNO 11417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Duluth, GA
• Providers in Duluth, 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 Oct 28, 2009; 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.