MEDICARE: DR. MERCEDES J MAYANS D.D.S.

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	122300000X	Dentist	0010110	FL

General Provider Information

NPI Number	:	1760417380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERCEDES J MAYANS D.D.S.

Provider Business Mailing Address
First Line	:	5333 COLLINS AVE APT 1202
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-5534
Country	:	US
Telephone Number	:	305-993-5287
Fax Number	:	305-267-3008

Provider Business Practice Location Address
First Line	:	6517 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1843
Country	:	US
Telephone Number	:	305-267-3377
Fax Number	:	305-267-3008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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