Organization
GREGG C MAZONAS DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGG C MAZONAS DDS (PRESIDENT)
(317) 392-3231
Entity
Organization
Contact information
Practice address
1818 N RILEY HWY, SHELBYVILLE, IN 46176-0070
(317) 392-3231
(317) 392-3233
Mailing address
PO BX 70, 2158 INTELLIPLEX DR, SHELBYVILLE, IN 46176-0070
(317) 392-3231
(317) 392-3233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008860A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200244850A
—
IN
Enumeration date
10/10/2006
Last updated
08/06/2008
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