Provider Demographics
NPI:1740544972
Name:MAYEMBE, TONI-ANN HYLTON (DDS)
Entity type:Individual
Prefix:
First Name:TONI-ANN
Middle Name:HYLTON
Last Name:MAYEMBE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TONI-ANN
Other - Middle Name:R
Other - Last Name:HYLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:926 GREAT POND DR STE 2002
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5149 NORMANDY BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4861
Practice Address - Country:US
Practice Address - Phone:904-781-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN197881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005962700Medicaid