MEDICARE: DR. DENNIS MORRIS MAHAN 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	19022461	IL

General Provider Information

NPI Number	:	1952389066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS MORRIS MAHAN D.M.D.

Provider Business Mailing Address
First Line	:	NAVAL HOSPITAL
Second Line	:	2080 CHILD ST
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-0001
Country	:	US
Telephone Number	:	904-542-7542
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL HOSPITAL
Second Line	:	2080 CHILD ST
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-0001
Country	:	US
Telephone Number	:	904-542-7542
Fax Number	:

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/22/2008

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