Provider Demographics
NPI:1023144482
Name:MASLAK, JOHN E (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:MASLAK
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 1:4025 W BELL RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2748
Mailing Address - Country:US
Mailing Address - Phone:602-439-4900
Mailing Address - Fax:602-978-6414
Practice Address - Street 1:4025 W BELL RD STE 1B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2748
Practice Address - Country:US
Practice Address - Phone:602-439-4900
Practice Address - Fax:602-978-6414
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD2578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist