Provider Demographics
NPI:1831642883
Name:MAURER, MICHAEL JON (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JON
Last Name:MAURER
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 1:773 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4631
Mailing Address - Country:US
Mailing Address - Phone:619-440-5915
Mailing Address - Fax:619-440-0605
Practice Address - Street 1:773 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4631
Practice Address - Country:US
Practice Address - Phone:619-440-5915
Practice Address - Fax:619-440-0605
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry