Provider Demographics
NPI:1871829051
Name:DANIEL GERARD MAHONEY DDS
Entity Type:Organization
Organization Name:DANIEL GERARD MAHONEY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:508-428-2443
Mailing Address - Street 1:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-0493
Mailing Address - Country:US
Mailing Address - Phone:508-428-2443
Mailing Address - Fax:
Practice Address - Street 1:21 POND STREET
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-0493
Practice Address - Country:US
Practice Address - Phone:508-428-2443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0227188Medicaid