Healthcare Provider Details

I. General information

NPI: 1265341796
Provider Name (Legal Business Name): MAYFIELD SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6593 WILSON MILLS RD
MAYFIELD VILLAGE OH
44143-3404
US

IV. Provider business mailing address

6593 WILSON MILLS RD
MAYFIELD VILLAGE OH
44143-3404
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-1230
  • Fax: 440-461-5458
Mailing address:
  • Phone: 440-461-1230
  • Fax: 440-461-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SANDRA KOTRIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 216-475-0505