MEDICARE: NEARINGMAYES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5543	OR

General Provider Information

NPI Number	:	1700174182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEARINGMAYES, LLC

Provider Business Mailing Address
First Line	:	1614 5TH ST
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-2516
Country	:	US
Telephone Number	:	541-963-8585
Fax Number	:	541-963-6633

Provider Business Practice Location Address
First Line	:	1614 5TH ST
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-2516
Country	:	US
Telephone Number	:	541-963-8585
Fax Number	:	541-963-6633

Authorized Official
Title or Position	:	DENTIST/ MANAGER
Name	:	DR. PATRICK M NEARING
Credential	:	DMD
Telephone Number	:	541-963-8585

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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