Provider Demographics
NPI:1255539045
Name:MACKAREY, MARIA GESIOTTO (DDS)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GESIOTTO
Last Name:MACKAREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SIMERELL RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8849
Mailing Address - Country:US
Mailing Address - Phone:570-586-4594
Mailing Address - Fax:570-586-3596
Practice Address - Street 1:632 DAVIS ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-4666
Practice Address - Country:US
Practice Address - Phone:570-969-1838
Practice Address - Fax:570-963-5790
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 027 288L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01411350Medicaid