Provider Demographics
NPI:1235160722
Name:MAYHEW, BILL KIRK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:KIRK
Last Name:MAYHEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5159 DOWNWEST RIDE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1505
Mailing Address - Country:US
Mailing Address - Phone:410-730-5127
Mailing Address - Fax:
Practice Address - Street 1:1434 PORTER STREET
Practice Address - Street 2:USA DENTAL CLINIC
Practice Address - City:FT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-619-7675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0173861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice