Provider Demographics
NPI:1609969617
Name:MAYO, JOHN LOUIS (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
Last Name:MAYO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 BOARDMAN POLAND RD
Mailing Address - Street 2:MAYO PROFESSIONAL CENTER
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5137
Mailing Address - Country:US
Mailing Address - Phone:330-758-7501
Mailing Address - Fax:330-758-0890
Practice Address - Street 1:750 BOARDMAN POLAND RD
Practice Address - Street 2:MAYO PROFESSIONAL CENTER
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5137
Practice Address - Country:US
Practice Address - Phone:330-758-7501
Practice Address - Fax:330-758-0890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398289Medicaid