Provider Demographics
NPI:1508267089
Name:MAYNE, SHERRY (RDH, MSAH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:MAYNE
Suffix:
Gender:F
Credentials:RDH, MSAH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 NEW BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-4032
Mailing Address - Country:US
Mailing Address - Phone:423-967-0417
Mailing Address - Fax:
Practice Address - Street 1:461 NEW BETHEL RD
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-4032
Practice Address - Country:US
Practice Address - Phone:423-967-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH4367124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist