MEDICARE: DR. STEPHEN BARRY MACKLER DDS,MS

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	1223P0300X	Periodontics	NC 3372	NC

General Provider Information

NPI Number	:	1942207543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN BARRY MACKLER DDS,MS

Provider Business Mailing Address
First Line	:	301 E WENDOVER AVE
Second Line	:	STE 315
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1231
Country	:	US
Telephone Number	:	336-379-8377
Fax Number	:	336-275-2078

Provider Business Practice Location Address
First Line	:	301 E WENDOVER AVE
Second Line	:	STE 315
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1231
Country	:	US
Telephone Number	:	336-379-8377
Fax Number	:	336-275-2078

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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