Provider Demographics
NPI:1891912879
Name:D.M.M GROUP, LLC
Entity Type:Organization
Organization Name:D.M.M GROUP, LLC
Other - Org Name:DONALD M MAYBERRY AND DAVID M MAYBERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-425-3093
Mailing Address - Street 1:100 HOSPITAL DRIVE MEDICAL CENTER
Mailing Address - Street 2:P O BOX 368
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713
Mailing Address - Country:US
Mailing Address - Phone:740-425-3093
Mailing Address - Fax:740-425-1714
Practice Address - Street 1:100 HOSPITAL DRIVE MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713
Practice Address - Country:US
Practice Address - Phone:740-425-3093
Practice Address - Fax:740-425-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164561223G0001X
OH104541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2680433Medicaid