Healthcare Provider Details

I. General information

NPI: 1710524426
Provider Name (Legal Business Name): MAUPIN ENDODONTICS & MICROSURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 82ND ST STE 300
LUBBOCK TX
79424-0822
US

IV. Provider business mailing address

6010 82ND ST STE 300
LUBBOCK TX
79424-0822
US

V. Phone/Fax

Practice location:
  • Phone: 806-589-3390
  • Fax:
Mailing address:
  • Phone: 806-589-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: FAITH GASKINS
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 972-869-3789