Provider Demographics
NPI:1225604705
Name:MAYBERRY, AARON (DMD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15631 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3117
Mailing Address - Country:US
Mailing Address - Phone:562-324-8720
Mailing Address - Fax:
Practice Address - Street 1:715 E BIRCH ST STE A
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5704
Practice Address - Country:US
Practice Address - Phone:714-790-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice