Provider Demographics
NPI:1295859742
Name:MAYES, ELISHA BRETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISHA
Middle Name:BRETT
Last Name:MAYES
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 1:1614 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2516
Mailing Address - Country:US
Mailing Address - Phone:541-963-8585
Mailing Address - Fax:541-963-6633
Practice Address - Street 1:1614 5TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2516
Practice Address - Country:US
Practice Address - Phone:541-963-8585
Practice Address - Fax:541-963-6633
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist