Provider Demographics
NPI:1780711432
Name:GERARDO F. MAYMI, D.M.D. PC
Entity type:Organization
Organization Name:GERARDO F. MAYMI, D.M.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:MMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-253-7553
Mailing Address - Street 1:2651 W SOUTH JORDAN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8953
Mailing Address - Country:US
Mailing Address - Phone:801-253-7553
Mailing Address - Fax:801-253-7553
Practice Address - Street 1:2651 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8953
Practice Address - Country:US
Practice Address - Phone:801-253-7553
Practice Address - Fax:801-253-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62299001223G0001X
UT1451481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty