Provider Demographics
NPI:1942471826
Name:DRS MAY AND MALLORY DDS PC
Entity Type:Organization
Organization Name:DRS MAY AND MALLORY DDS PC
Other - Org Name:BRETON GARDENS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-455-0720
Mailing Address - Street 1:4144 BRETON RD SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3856
Mailing Address - Country:US
Mailing Address - Phone:616-455-0720
Mailing Address - Fax:616-455-0815
Practice Address - Street 1:4144 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-3856
Practice Address - Country:US
Practice Address - Phone:616-455-0720
Practice Address - Fax:616-455-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI150531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4234026Medicaid
MI4234035Medicaid