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NPI Code Detail

MEDICARE: JOHN PHILLIP MASEL D.D.S.

MEDICARE: JOHN PHILLIP MASEL 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
1122300000XDentist5001685WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15001685OTHERWIDENTAL LICENSE

General Provider Information

NPI Number : 1639280811
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PHILLIP MASEL D.D.S.
Provider Business Mailing Address
First Line : 2130 W BOLIVAR AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-2214
Country : US
Telephone Number : 414-282-9783
Fax Number :
Provider Business Practice Location Address
First Line : 1401 W OKLAHOMA AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4623
Country : US
Telephone Number : 414-671-4848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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