Provider Demographics
NPI:1649331794
Name:ACCORNERO, MAYTE (DMD)
Entity type:Individual
Prefix:DR
First Name:MAYTE
Middle Name:
Last Name:ACCORNERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PRESTON EXECUTIVE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8485
Mailing Address - Country:US
Mailing Address - Phone:919-469-6683
Mailing Address - Fax:919-469-6636
Practice Address - Street 1:150 PRESTON EXECUTIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8485
Practice Address - Country:US
Practice Address - Phone:919-469-6683
Practice Address - Fax:919-469-6636
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84801223X0400X, 122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649331794Medicaid