Individual
DR. JASUN MAHAFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
388 PARK AVE, WORCESTER, MA 01610-1025
(508) 798-6565
(508) 798-6687
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DL10614
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN1855938
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110092502A
—
MA
Enumeration date
10/21/2009
Last updated
02/05/2014
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