# GREGG C MAZONAS DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518054428
- **Authorized official:** GREGG C MAZONAS DDS (PRESIDENT)
- **Authorized official phone:** (317) 392-3231

## Contact information

- **Practice address:** 1818 N RILEY HWY, SHELBYVILLE, IN 46176-0070
- **Practice address phone:** (317) 392-3231
- **Practice address fax:** (317) 392-3233
- **Mailing address:** PO BX 70, 2158 INTELLIPLEX DR, SHELBYVILLE, IN 46176-0070
- **Mailing address phone:** (317) 392-3231
- **Mailing address fax:** (317) 392-3233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12008860A | IN | Yes |

## Other

- **Enumeration date:** 10/10/2006
- **Last updated:** 08/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200244850A | — | IN |