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NPI Code Detail

MEDICARE: MICHAEL JOHN MAUREN D.D.S.

MEDICARE: MICHAEL JOHN MAUREN D.D.S.
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
11223G0001XGeneral Practice Dentistry2901015857MI

General Provider Information

NPI Number : 1245432780
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JOHN MAUREN D.D.S.
Provider Business Mailing Address
First Line : 8037 ABBEY RD
Second Line :
City : PORTLAND
State : MI
Zip : 48875-9364
Country : US
Telephone Number : 517-647-0081
Fax Number : 517-647-0083
Provider Business Practice Location Address
First Line : 9751 E GRAND RIVER AVE
Second Line :
City : PORTLAND
State : MI
Zip : 48875-9774
Country : US
Telephone Number : 517-647-0081
Fax Number : 517-647-0083
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 03/04/2021

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