Provider Demographics
NPI:1497836746
Name:MAYES, LISA HAUSER (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HAUSER
Last Name:MAYES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 NW CARY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8438
Mailing Address - Country:US
Mailing Address - Phone:919-460-0963
Mailing Address - Fax:919-319-1385
Practice Address - Street 1:3761 NW CARY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8438
Practice Address - Country:US
Practice Address - Phone:919-460-0963
Practice Address - Fax:919-319-1385
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice