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NPI Code Detail

MEDICARE: SUSAN M MAURER D.M.D.

MEDICARE: SUSAN M MAURER D.M.D.
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
11223P0221XPediatric DentistryIL

Other Identifiers

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

General Provider Information

NPI Number : 1730243296
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M MAURER D.M.D.
Provider Business Mailing Address
First Line : 3020 HAPPY LANDING DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-6259
Country : US
Telephone Number : 217-546-9166
Fax Number : 217-546-7804
Provider Business Practice Location Address
First Line : 3020 HAPPY LANDING DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-6259
Country : US
Telephone Number : 217-546-9166
Fax Number : 217-546-7804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 07/08/2007

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