Provider Demographics
NPI:1154319457
Name:MAYERLE, JAMES L
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:MAYERLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2625
Mailing Address - Country:US
Mailing Address - Phone:952-448-2577
Mailing Address - Fax:
Practice Address - Street 1:104 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2625
Practice Address - Country:US
Practice Address - Phone:952-448-2577
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice