Provider Demographics
NPI:1275632143
Name:STEPHEN J MAYO DDS & RYAN C MAYO DDS PC
Entity Type:Organization
Organization Name:STEPHEN J MAYO DDS & RYAN C MAYO DDS PC
Other - Org Name:MAYO FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT RELATIONS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAROLYN
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-777-3510
Mailing Address - Street 1:22 DAVIS AVE SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175
Mailing Address - Country:US
Mailing Address - Phone:703-777-3510
Mailing Address - Fax:703-777-9488
Practice Address - Street 1:22 DAVIS AVE SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:703-777-3510
Practice Address - Fax:703-777-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty