Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | D010510 | AZ |
Y | 1223P0300X | Periodontist | D11731 | MN |
NPI | 1144570938 |
---|---|
Provider Name | Dr. Jules Luke Mascarenhas |
First Address | Gilbert, AZ 85297-8132 |
Second Address | Chandler, AZ 85286-1410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 11/03/2020 |