Provider Demographics
NPI:1629122106
Name:MICHAEL J MAYHEW DDS MS PA
Entity Type:Organization
Organization Name:MICHAEL J MAYHEW DDS MS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST PEDIATRIC DENTIST PRES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:828-264-0110
Mailing Address - Street 1:373 BOONE HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-264-0110
Mailing Address - Fax:828-264-5453
Practice Address - Street 1:373 BOONE HEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-264-0110
Practice Address - Fax:828-264-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty