Provider Demographics
NPI:1558406579
Name:MAULEON, LUIS THELMO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:THELMO
Last Name:MAULEON
Suffix:JR
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 1:501 N CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3670
Mailing Address - Country:US
Mailing Address - Phone:607-272-8118
Mailing Address - Fax:607-272-4114
Practice Address - Street 1:501 N CAYUGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3670
Practice Address - Country:US
Practice Address - Phone:607-272-8118
Practice Address - Fax:607-272-4114
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0442971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice