Healthcare Provider Details

I. General information

NPI: 1730243296
Provider Name (Legal Business Name): SUSAN M MAURER D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAPPY LANDING DR
SPRINGFIELD IL
62711-6259
US

IV. Provider business mailing address

3020 HAPPY LANDING DR
SPRINGFIELD IL
62711-6259
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-9166
  • Fax: 217-546-7804
Mailing address:
  • Phone: 217-546-9166
  • Fax: 217-546-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: