MEDICARE: JOHN E MASLAK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D2578	AZ

General Provider Information

NPI Number	:	1023144482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E MASLAK DDS

Provider Business Mailing Address
First Line	:	4025 W BELL RD STE 1B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2748
Country	:	US
Telephone Number	:	602-439-4900
Fax Number	:	602-978-6414

Provider Business Practice Location Address
First Line	:	4025 W BELL RD STE 1B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2748
Country	:	US
Telephone Number	:	602-439-4900
Fax Number	:	602-978-6414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	10/30/2017

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Directions to “ JOHN E MASLAK DDS” Practice Location

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