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General NPI Number Information
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NPI Number | 1457564122
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Entity Type | Organization
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Legal Business Name | JOHN MASLAK DDS PC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4901 W BELL RD SUITE 1
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 602-439-4900
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Fax | 602-978-6414
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Provider Business Mailing Address
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Address Line | 4901 W BELL RD SUITE 1
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 602-439-4900
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Fax | 602-978-6414
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Authorized Official
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Title or Position | OWNER DENTIST CEO
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Name | JOHN E MASLAK
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Credential | DDS PC
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Telephone | 602-439-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D2578
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License Number State | AZ
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