MEDICARE: DR. MAURICIO WILTZ 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)	043995	NY
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	043995	NY

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	:	1760485247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICIO WILTZ D.D.S.

Provider Business Mailing Address
First Line	:	36 HALSTEAD AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10704-3008
Country	:	US
Telephone Number	:	914-237-9094
Fax Number	:	718-515-5419

Provider Business Practice Location Address
First Line	:	3332 ROCHAMBEAU AVENUE
Second Line	:	DEPARTMENT OF DENTISTRY, 2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10467-2836
Country	:	US
Telephone Number	:	718-920-4984
Fax Number	:	718-515-5419

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/26/2019

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Directions to “ DR. MAURICIO WILTZ D.D.S.” Practice Location

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