MEDICARE: DR. MICHAEL JOSEPH MACCARO D.M.D.

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	122300000X	Dentist	16775	FL
2	1223P0221X	Pediatric Dentistry	D010318	AZ

General Provider Information

NPI Number	:	1790787810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH MACCARO D.M.D.

Provider Business Mailing Address
First Line	:	944 E STERLING LN
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86005-6571
Country	:	US
Telephone Number	:	928-310-7130
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 N ALAMOS DR
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4020
Country	:	US
Telephone Number	:	928-634-6641
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/15/2023

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