MEDICARE: DR. PAUL R MACO 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
1	1223G0001X	General Practice Dentistry	019021190	IL

General Provider Information

NPI Number	:	1689679706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL R MACO D.D.S.

Provider Business Mailing Address
First Line	:	4323 CHAMPION HILL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29207-6022
Country	:	US
Telephone Number	:	803-751-1624
Fax Number	:

Provider Business Practice Location Address
First Line	:	4590 STROM THURMOND BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29207-5305
Country	:	US
Telephone Number	:	803-751-5178
Fax Number	:

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/01/2025

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