MEDICARE: DR. ERIN MARISCAL 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	122300000X	Dentist	2003013103	MO
2	1223G0001X	General Practice Dentistry	2003013103	MO

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	:	1740279967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN MARISCAL D.D.S.

Provider Business Mailing Address
First Line	:	124 RICHARDSON XING
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6023
Country	:	US
Telephone Number	:	636-464-6444
Fax Number	:	636-464-6465

Provider Business Practice Location Address
First Line	:	124 RICHARDSON XING
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-6023
Country	:	US
Telephone Number	:	636-464-6444
Fax Number	:	636-464-6465

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/13/2021

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