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General NPI Number Information
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NPI Number | 1619127461
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Entity Type | Individual
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Provider Name | ANN MARIE MAGGIO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 2915 E SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6626
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Country | US
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Telephone | 817-481-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 2915 E SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6626
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Country | US
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Telephone | 817-481-6553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019.027801
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS0000011076
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31564
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License Number State | TX
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