Provider Demographics
NPI:1326337353
Name:MACIAG, JOSEPH (HS3)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MACIAG
Suffix:
Gender:M
Credentials:HS3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COAST GUARD SECTOR SAN JUAN
Mailing Address - Street 2:5 CALLE LA PUNTILLA
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:00901-0100
Mailing Address - Country:US
Mailing Address - Phone:787-729-4344
Mailing Address - Fax:787-729-2337
Practice Address - Street 1:5 CALLE LA PUNTILLA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1818
Practice Address - Country:US
Practice Address - Phone:787-729-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant