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General NPI Number Information
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NPI Number | 1487737672
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Entity Type | Organization
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Legal Business Name | JOSEPH J. MASCARO, DMD,PSC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8516 PRESTON HWY
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City | LOUISVILLE
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State | KY
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Zip | 40219-5302
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Country | US
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Telephone | 502-969-2523
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Fax |
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Provider Business Mailing Address
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Address Line | 2015 HERR LN SUITE E
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City | LOUISVILLE
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State | KY
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Zip | 40222-6567
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Country | US
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Telephone | 502-429-6506
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Fax | 502-429-6530
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Authorized Official
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Title or Position | ORESIDENT
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Name | DR. JOSEPH JOHN MASCARO
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Credential | DMD
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Telephone | 502-429-6506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4617
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License Number State | KY
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