MEDICARE: JOHN W. MASHNI, D.D.S., P.C.

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	1223G0001X	General Practice Dentistry	11096	MI

General Provider Information

NPI Number	:	1992966766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN W. MASHNI, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	2121 ABBOT RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8535
Country	:	US
Telephone Number	:	517-351-1733
Fax Number	:	517-351-5709

Provider Business Practice Location Address
First Line	:	2121 ABBOT RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8535
Country	:	US
Telephone Number	:	517-351-1733
Fax Number	:	517-351-5709

Authorized Official
Title or Position	:	DENTIST
Name	:	JOHN WADIE MASHNI
Credential	:	D.D.S.
Telephone Number	:	517-351-1733

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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