Provider Demographics
NPI:1497809883
Name:MAYFAIR DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:MAYFAIR DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-779-0023
Mailing Address - Street 1:3 MICHAEL FREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709
Mailing Address - Country:US
Mailing Address - Phone:914-779-0023
Mailing Address - Fax:914-779-0427
Practice Address - Street 1:3 MICHAEL FREY DRIVE
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709
Practice Address - Country:US
Practice Address - Phone:914-779-0023
Practice Address - Fax:914-779-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty