Provider Demographics
NPI:1609012996
Name:MCENTIRE, MAYES (DMD)
Entity Type:Individual
Prefix:
First Name:MAYES
Middle Name:
Last Name:MCENTIRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4313
Mailing Address - Country:US
Mailing Address - Phone:803-782-7722
Mailing Address - Fax:803-782-4573
Practice Address - Street 1:4023 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4313
Practice Address - Country:US
Practice Address - Phone:803-782-7722
Practice Address - Fax:803-782-4573
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics