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General NPI Number Information
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NPI Number | 1790382968
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Entity Type | Individual
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Provider Name | SHANE MICHAEL MAULE DDS
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Gender | Male
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 20800 W MARKET ST STE 107
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City | BUCKEYE
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State | AZ
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Zip | 85396-8040
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Country | US
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Telephone | 480-650-9798
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 E POTTER DR
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City | PHOENIX
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State | AZ
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Zip | 85024-4334
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Country | US
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Telephone | 480-650-9798
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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 | D010882
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License Number State | AZ
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