MEDICARE: DR. DAVID L MAPES 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	4324-015	WI

General Provider Information

NPI Number	:	1801880588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L MAPES D.D.S.

Provider Business Mailing Address
First Line	:	375 MEDICAL GROUP
Second Line	:	310 WEST LOSEY ST
City	:	SCOTT, AFB
State	:	IL
Zip	:	62225
Country	:	US
Telephone Number	:	618-256-7175
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 TRUEMPER ST
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-671-9970
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	09/17/2020

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