Individual
SCOTT JOSEPH MAZZULO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10102 NE GLISAN ST, PORTLAND, OR 97220-4456
(704) 909-8509
Mailing address
11296 SE AQUILA ST, HAPPY VALLEY, OR 97086-7670
(704) 909-8509
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H8536
OR
Other
Enumeration date
11/04/2022
Last updated
11/04/2022
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