MEDICARE: LAUREN MAISANO

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	7550	LA

General Provider Information

NPI Number	:	1679312227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MAISANO

Provider Business Mailing Address
First Line	:	706 RUE MARSEILLE
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-1237
Country	:	US
Telephone Number	:	504-615-4277
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 W THOMAS ST
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-3038
Country	:	US
Telephone Number	:	985-345-2285
Fax Number	:

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

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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Directions to “ LAUREN MAISANO ” Practice Location

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