MEDICARE: DR. MARY BELL MALTEZOS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3972	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215155817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BELL MALTEZOS D.M.D.

Provider Business Mailing Address
First Line	:	3931 COLONEL VANDERHORST CIR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-8035
Country	:	US
Telephone Number	:	843-884-9137
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 N HIGHWAY 17 STE 101
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9300
Country	:	US
Telephone Number	:	843-849-9990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	04/27/2018

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