Provider Demographics
NPI:1508805607
Name:MAURO, JOSEPH VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:MAURO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1478
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-1478
Mailing Address - Country:US
Mailing Address - Phone:517-272-0886
Mailing Address - Fax:517-272-0887
Practice Address - Street 1:231 W. LAKE LANSING RD, SUITE 200
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8451
Practice Address - Country:US
Practice Address - Phone:517-272-0886
Practice Address - Fax:517-272-0887
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM0124121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery