Provider Demographics
NPI:1750532818
Name:MAYER, MICHELLE M (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:MAYER
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 1:881 USS JAMES MADISON RD
Mailing Address - Street 2:NBHC DENTAL DEPARTMENT
Mailing Address - City:KINGS BAY
Mailing Address - State:GA
Mailing Address - Zip Code:31547
Mailing Address - Country:US
Mailing Address - Phone:912-573-4212
Mailing Address - Fax:912-573-2085
Practice Address - Street 1:105 CONNECTICUT RD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6117
Practice Address - Country:US
Practice Address - Phone:239-369-5861
Practice Address - Fax:239-369-7121
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist