Provider Demographics
NPI:1942854922
Name:CHESTER MAYO DMD, P.C.
Entity Type:Organization
Organization Name:CHESTER MAYO DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:757-486-5428
Mailing Address - Street 1:477 VIKING DRIVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7349
Mailing Address - Country:US
Mailing Address - Phone:757-486-5428
Mailing Address - Fax:757-486-4826
Practice Address - Street 1:477 VIKING DR STE 215
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7349
Practice Address - Country:US
Practice Address - Phone:757-486-5428
Practice Address - Fax:757-486-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty