Provider Demographics
NPI:1659667731
Name:MAUCK, MATT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:MAUCK
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 1:3131 S VAUGHN WAY STE 422
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3508
Mailing Address - Country:US
Mailing Address - Phone:303-745-1400
Mailing Address - Fax:
Practice Address - Street 1:3131 S VAUGHN WAY STE 422
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3508
Practice Address - Country:US
Practice Address - Phone:303-745-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist