Provider Demographics
NPI:1467550327
Name:PERSAUD & MAYO LLC
Entity Type:Organization
Organization Name:PERSAUD & MAYO LLC
Other - Org Name:PROVIDENCE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEWAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-489-5600
Mailing Address - Street 1:475 PROVIDENCE MAIN ST NW
Mailing Address - Street 2:SUITE #301
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4815
Mailing Address - Country:US
Mailing Address - Phone:256-489-5600
Mailing Address - Fax:256-489-5640
Practice Address - Street 1:475 PROVIDENCE MAIN ST NW
Practice Address - Street 2:SUITE #301
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4815
Practice Address - Country:US
Practice Address - Phone:256-489-5600
Practice Address - Fax:256-489-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty