MEDICARE: EMILY E MASCIOVECCHIO RDH

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	124Q00000X	Dental Hygienist	DH044636	GA

General Provider Information

NPI Number	:	1770277717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY E MASCIOVECCHIO RDH

Provider Business Mailing Address
First Line	:	5801 DEARBORN AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-5539
Country	:	US
Telephone Number	:	706-405-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	2326 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6860
Country	:	US
Telephone Number	:	706-324-1415
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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