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General NPI Number Information
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NPI Number | 1689859589
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Entity Type | Organization
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Legal Business Name | JOHN MASCARO D M D M D AND CARL CHOI D D S M D INC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 4230 STATE ROUTE 306 STE 350
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City | WILLOUGHBY
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State | OH
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Zip | 44094-9213
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Country | US
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Telephone | 440-946-2247
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Fax | 440-946-3530
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Provider Business Mailing Address
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Address Line | 4230 STATE ROUTE 306 STE 350
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City | WILLOUGHBY
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State | OH
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Zip | 44094-9213
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Country | US
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Telephone | 440-946-2247
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Fax | 440-946-3530
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN MASCARO
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Credential | D M D M D
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Telephone | 440-946-2247
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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 |
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License Number State |
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