Provider Demographics
NPI:1598982225
Name:DONALD R MAYER, D.D.S., P.A.
Entity Type:Organization
Organization Name:DONALD R MAYER, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-681-3479
Mailing Address - Street 1:215 S HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2128
Mailing Address - Country:US
Mailing Address - Phone:316-681-3479
Mailing Address - Fax:316-681-0346
Practice Address - Street 1:215 S HILLSIDE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2128
Practice Address - Country:US
Practice Address - Phone:316-681-3479
Practice Address - Fax:316-681-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty