Organization
MARK A. MASTELLOTTO
Active
Other names
Mark Mastellotto DDS PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ARTHUR MASTELLOTTO DDS (OWNER)
(517) 263-0338
Entity
Organization
Contact information
Practice address
760 RIVERSIDE AVE, ADRIAN, MI 49221-1445
(517) 263-0338
(517) 263-1138
Mailing address
760 RIVERSIDE AVE, ADRIAN, MI 49221-1445
(517) 263-0338
(517) 263-1138
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013077601
ALL INSURANCE
MI
01
—
1013077601
ALL INSURANCE
—
05
—
1013077601
—
MI
Enumeration date
11/07/2022
Last updated
11/07/2022
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