Provider Demographics
NPI:1629122866
Name:DR EMILY J MAYHEW AND DR EDWARD SMITH, INC
Entity Type:Organization
Organization Name:DR EMILY J MAYHEW AND DR EDWARD SMITH, INC
Other - Org Name:MAYHEW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-535-2409
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-0200
Mailing Address - Country:US
Mailing Address - Phone:304-535-2409
Mailing Address - Fax:304-535-2408
Practice Address - Street 1:1238 WEST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425
Practice Address - Country:US
Practice Address - Phone:304-535-2409
Practice Address - Fax:304-535-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7329721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135616000Medicaid