Healthcare Provider Details

I. General information

NPI: 1992908719
Provider Name (Legal Business Name): STEPHEN PAUL MAYO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 HWY 11W SUITE F
BEAN STATION TN
37708
US

IV. Provider business mailing address

PO BOX 130
BEAN STATION TN
37708-0130
US

V. Phone/Fax

Practice location:
  • Phone: 865-993-2225
  • Fax:
Mailing address:
  • Phone: 865-993-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS6933
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: