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Organization

VINEYARDS DENTAL CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THOMAS J. MAZZUCKELLI PHD., D.M.D. (OWNER)
(770) 868-4288
Entity
Organization

Contact information

Practice address
2095 HIGHWAY 211 NW, SUITE 6-A, BRASELTON, GA 30517-3402
(770) 868-4288
(770) 868-4291
Mailing address
2095 HIGHWAY 211 NW, SUITE 6-A, BRASELTON, GA 30517-3402
(770) 868-4288
(770) 868-4291

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DNO 14417
GA

Other

Enumeration date
12/18/2006
Last updated
08/22/2020
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