MEDICARE: DR. JOSEPH VINCENT MAURO D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	JM012412	MI

General Provider Information

NPI Number	:	1508805607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH VINCENT MAURO D.D.S.

Provider Business Mailing Address
First Line	:	P.O. BOX 1478
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48826-1478
Country	:	US
Telephone Number	:	517-272-0886
Fax Number	:	517-272-0887

Provider Business Practice Location Address
First Line	:	231 W. LAKE LANSING RD, SUITE 200
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8451
Country	:	US
Telephone Number	:	517-272-0886
Fax Number	:	517-272-0887

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	05/10/2022

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