Provider Demographics
NPI:1952415259
Name:NG, MAVIS (DDS)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2703
Mailing Address - Country:US
Mailing Address - Phone:315-255-1171
Mailing Address - Fax:315-252-7801
Practice Address - Street 1:144 GENESEE ST
Practice Address - Street 2:METCALF PLAZA SUITE 303
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3503
Practice Address - Country:US
Practice Address - Phone:315-255-9294
Practice Address - Fax:315-255-9296
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist