Provider Demographics
NPI:1104063585
Name:HEALEY, MAURICE IRVIN I
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:IRVIN
Last Name:HEALEY
Suffix:I
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MAURICE
Other - Middle Name:IRVIN
Other - Last Name:HEALEY
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:DENTIST
Mailing Address - Street 1:2189 CLEVELAND ST.
Mailing Address - Street 2:SUITE 252
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3243
Mailing Address - Country:US
Mailing Address - Phone:727-461-9149
Mailing Address - Fax:
Practice Address - Street 1:5215 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3742
Practice Address - Country:US
Practice Address - Phone:941-792-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist