Provider Demographics
NPI:1790462778
Name:MAYLOR, KATELYN ELAINE (RDH)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELAINE
Last Name:MAYLOR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 567 BOX 7020
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96384-0071
Mailing Address - Country:US
Mailing Address - Phone:330-844-6774
Mailing Address - Fax:
Practice Address - Street 1:3D DENTAL BATTALION, 3D MLG
Practice Address - Street 2:UNIT 38450
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96373
Practice Address - Country:US
Practice Address - Phone:378-109-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402208035124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist