Provider Demographics
NPI:1487737672
Name:JOSEPH J. MASCARO, DMD,PSC
Entity type:Organization
Organization Name:JOSEPH J. MASCARO, DMD,PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MASCARO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-429-6506
Mailing Address - Street 1:2015 HERR LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6567
Mailing Address - Country:US
Mailing Address - Phone:502-429-6506
Mailing Address - Fax:502-429-6530
Practice Address - Street 1:8516 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5302
Practice Address - Country:US
Practice Address - Phone:502-969-2523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty