Provider Demographics
NPI:1366947368
Name:MAZON, ABIGAIL ANNE (DDS)
Entity type:Individual
Prefix:
First Name:ABIGAIL ANNE
Middle Name:
Last Name:MAZON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18550 FIRLANDS WAY N STE 200
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3984
Mailing Address - Country:US
Mailing Address - Phone:206-546-4161
Mailing Address - Fax:
Practice Address - Street 1:290 N WAYTE LN STE 2500
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2124
Practice Address - Country:US
Practice Address - Phone:559-459-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032038122300000X
390200000X
WADE61178650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program