MEDICARE: DR. MAURICIO MARCUSHAMER 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	1223P0221X	Pediatric Dentistry	18580	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699842690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICIO MARCUSHAMER DDS

Provider Business Mailing Address
First Line	:	3006 BROADWAY STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1561
Country	:	US
Telephone Number	:	210-225-8888
Fax Number	:	210-225-4195

Provider Business Practice Location Address
First Line	:	3006 BROADWAY STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1561
Country	:	US
Telephone Number	:	210-225-8888
Fax Number	:	210-225-4195

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	01/25/2024

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