Provider Demographics
NPI:1952454894
Name:MAYHUE, TOMMY LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:LEO
Last Name:MAYHUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-0575
Mailing Address - Country:US
Mailing Address - Phone:405-485-2020
Mailing Address - Fax:405-485-8779
Practice Address - Street 1:1119 N. COUNCIL RD.
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-0575
Practice Address - Country:US
Practice Address - Phone:405-485-2020
Practice Address - Fax:405-485-8779
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice