Provider Demographics
NPI:1033322102
Name:MAHON, JOHN ALBIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBIN
Last Name:MAHON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 HOLLYWOOD BLVD
Mailing Address - Street 2:#400
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020
Mailing Address - Country:US
Mailing Address - Phone:954-922-5011
Mailing Address - Fax:954-922-5011
Practice Address - Street 1:2450 HOLLYWOOD BLVD
Practice Address - Street 2:#400
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:954-922-5011
Practice Address - Fax:954-922-5011
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist