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General NPI Number Information
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NPI Number | 1851654677
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Entity Type | Organization
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Legal Business Name | MICHAEL G. MAUCK, D.M.D., P.A.
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1051 S STATE ROAD 7 STE 1
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City | WELLINGTON
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State | FL
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Zip | 33414-6135
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Country | US
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Telephone | 561-790-0206
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Fax | 561-795-5445
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Provider Business Mailing Address
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Address Line | 1051 S STATE ROAD 7 STE 1
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City | WELLINGTON
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State | FL
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Zip | 33414-6135
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Country | US
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Telephone | 561-790-0206
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Fax | 561-795-5445
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL G MAUCK
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Credential | DMD
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Telephone | 561-790-0206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | DN9881
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License Number State | FL
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