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Organization
TRAVERSE DENTAL ASSOCIATES, PLLC
Active
Organization
TRAVERSE DENTAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER D MAZZOLA (OWNER)
(734) 657-1854
Entity
Organization
Contact information
Practice address
555 SOUTH GARFIELD AVE, TRAVERSE CITY, MI 49686-3423
(231) 947-0210
(231) 947-6770
Mailing address
555 SOUTH GARFIELD AVE, TRAVERSE CITY, MI 49686-3423
(231) 947-0210
(231) 947-6770
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12127
MI
1223G0001X
General Practice Dentistry
12516
MI
1223G0001X
General Practice Dentistry
13833
MI
1223G0001X
General Practice Dentistry
Primary
2901019122
MI
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
07/07/2006
Last updated
03/23/2022
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