Healthcare Provider Details

I. General information

NPI: 1487737672
Provider Name (Legal Business Name): JOSEPH J. MASCARO, DMD,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8516 PRESTON HWY
LOUISVILLE KY
40219-5302
US

IV. Provider business mailing address

2015 HERR LN SUITE E
LOUISVILLE KY
40222-6567
US

V. Phone/Fax

Practice location:
  • Phone: 502-969-2523
  • Fax:
Mailing address:
  • Phone: 502-429-6506
  • Fax: 502-429-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4617
License Number StateKY

VIII. Authorized Official

Name: DR. JOSEPH JOHN MASCARO
Title or Position: ORESIDENT
Credential: DMD
Phone: 502-429-6506