Provider Demographics
NPI:1841756848
Name:AMANDA G. MAYES, DMD
Entity Type:Organization
Organization Name:AMANDA G. MAYES, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-479-2240
Mailing Address - Street 1:2520 PERRY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-5219
Mailing Address - Country:US
Mailing Address - Phone:360-479-2240
Mailing Address - Fax:
Practice Address - Street 1:2520 PERRY AVE STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-5219
Practice Address - Country:US
Practice Address - Phone:360-479-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental