Provider Demographics
NPI:1740319375
Name:MAYFIELD FAMILY & COSMETIC DENTISTRY LLC
Entity type:Organization
Organization Name:MAYFIELD FAMILY & COSMETIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-661-6405
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:12117
Mailing Address - Country:US
Mailing Address - Phone:518-661-6405
Mailing Address - Fax:518-661-7765
Practice Address - Street 1:2540 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:NY
Practice Address - Zip Code:12117
Practice Address - Country:US
Practice Address - Phone:518-661-6405
Practice Address - Fax:518-661-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental