Healthcare Provider Details

I. General information

NPI: 1790213486
Provider Name (Legal Business Name): TY ALLEN MAYS JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 W ARLINGTON AVE
WEATHERFORD OK
73096-2845
US

IV. Provider business mailing address

516 W ARLINGTON AVE
WEATHERFORD OK
73096-2845
US

V. Phone/Fax

Practice location:
  • Phone: 580-302-3726
  • Fax:
Mailing address:
  • Phone: 580-302-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6924
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number061661
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number142031539924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: