Provider Demographics
NPI:1982828950
Name:MAYMI, GERARDO F (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:F
Last Name:MAYMI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:F
Other - Last Name:MAYMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3672 W SOUTH JORDAN PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7171
Mailing Address - Country:US
Mailing Address - Phone:801-253-7553
Mailing Address - Fax:801-253-7722
Practice Address - Street 1:3672 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7171
Practice Address - Country:US
Practice Address - Phone:801-253-7553
Practice Address - Fax:801-253-7722
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1451481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice