# JOHN MASCARO D M D M D AND CARL CHOI D D S M D INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Great Lakes Jaw and Implant Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689859589
- **Authorized official:** JOHN MASCARO D M D M D (PRESIDENT)
- **Authorized official phone:** (440) 946-2247

## Contact information

- **Practice address:** 4230 STATE ROUTE 306 STE 350, WILLOUGHBY, OH 44094-9213
- **Practice address phone:** (440) 946-2247
- **Practice address fax:** (440) 946-3530
- **Mailing address:** 4230 STATE ROUTE 306 STE 350, WILLOUGHBY, OH 44094-9213
- **Mailing address phone:** (440) 946-2247
- **Mailing address fax:** (440) 946-3530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2008
- **Last updated:** 06/16/2010