Provider Demographics
NPI:1881808228
Name:MAYER, CRAIG A (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:MAYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CONNECTICUT RD
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6117
Mailing Address - Country:US
Mailing Address - Phone:239-369-5861
Mailing Address - Fax:239-369-7121
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:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist