Provider Demographics
NPI:1801614912
Name:MAYO, ALEXUS (RDH, OMT)
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 PATTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AQUILLA
Mailing Address - State:TX
Mailing Address - Zip Code:76622-2585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1309 ANNA LEA LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0505
Practice Address - Country:US
Practice Address - Phone:254-366-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23810124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist