MEDICARE: DR. MICHAEL PATRICK MAHONEY DDS

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	122300000X	Dentist	9887	MD
2	122300000X	Dentist	DS028015L	PA
3	1223G0001X	General Practice Dentistry	DS028015L	PA
4	1223G0001X	General Practice Dentistry	DEN.00202425	CO

General Provider Information

NPI Number	:	1255380309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PATRICK MAHONEY DDS

Provider Business Mailing Address
First Line	:	1667 COCHRANE CIR BLDG 7495
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-526-5537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1667 COCHRANE CIR BLDG 7495
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-526-5537
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/13/2023

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