MEDICARE: ALYSIA MEGAN MASCOLO DDS

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	12919	CT
2	122300000X	Dentist	106764	CA

General Provider Information

NPI Number	:	1992300578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSIA MEGAN MASCOLO DDS

Provider Business Mailing Address
First Line	:	8265 VILLAGE PKWY STE A
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-833-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8265 VILLAGE PKWY STE A
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-1254
Country	:	US
Telephone Number	:	925-833-0500
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	08/03/2021

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