Provider Demographics
NPI:1235255373
Name:MAYER, PHILIP GEORGE (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:GEORGE
Last Name:MAYER
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 1:1121 PEBBLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-3807
Mailing Address - Country:US
Mailing Address - Phone:218-739-7254
Mailing Address - Fax:218-739-7253
Practice Address - Street 1:1121 PEBBLE LAKE RD
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-3807
Practice Address - Country:US
Practice Address - Phone:218-739-7254
Practice Address - Fax:218-739-7253
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND88401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice