Provider Demographics
NPI:1588747687
Name:MASCARO, JOSEPH JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:MASCARO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2015 HERR LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6567
Mailing Address - Country:US
Mailing Address - Phone:502-429-6506
Mailing Address - Fax:502-429-6530
Practice Address - Street 1:8516 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5302
Practice Address - Country:US
Practice Address - Phone:502-969-2523
Practice Address - Fax:502-969-5304
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY46171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery