Provider Demographics
NPI:1235286642
Name:MAYFIELD, SAMUEL BOWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BOWEN
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4341 GAUTIER VANCLEAVE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-4825
Mailing Address - Country:US
Mailing Address - Phone:228-497-9844
Mailing Address - Fax:228-497-9499
Practice Address - Street 1:4341 GAUTIER VANCLEAVE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-4825
Practice Address - Country:US
Practice Address - Phone:228-497-9844
Practice Address - Fax:228-497-9499
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0-31-711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics