NPIMap

Organization Active NPI

Walter M. Mazzella, D.D.S., P.C.

  • General Practice Dentistry
  • Woodstock, MD
National Provider Identifier
1881787513
Registry record updated Aug 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12129 Issued in MD
Legal business name
WALTER M. MAZZELLA, D.D.S., P.C.
Practice address
10775 Birmingham Way
Suite 1
Woodstock, MD 21163-1425
Phone
(410) 203-2552
Fax
(410) 203-2546
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2007

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

Authorized official

Name
Walter Matthew Mazzella, D.D.S.NPI 1487990099
Title
President Ceo
Phone
(410) 203-2552

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12129 MD Primary

Addresses

Primary practice location

10775 Birmingham Way
Suite 1
Woodstock, MD 21163-1425

Mailing address

10775 Birmingham Way
Suite 1
Woodstock, MD 21163-1425
Phone (410) 203-2552

National Provider Directory

National Provider Directory

Locations

10775 Birmingham Way
Ste 1
Woodstock, MD 21163
Phone (410) 203-2552

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187568000000",
    "number": "1881787513",
    "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",
            "fax_number": "410-203-2546"
        },
        {
            "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",
            "fax_number": "410-203-2546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER M. MAZZELLA, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-08-20",
        "status": "A",
        "authorized_official_last_name": "MAZZELLA",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "410-203-2552",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.