Healthcare Provider Details

I. General information

NPI: 1003142597
Provider Name (Legal Business Name): NORTH MESA DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 N MESA ST STE C
EL PASO TX
79912-4446
US

IV. Provider business mailing address

400 GALLERIA PKWY SE STE 800
ATLANTA GA
30339-6413
US

V. Phone/Fax

Practice location:
  • Phone: 800-920-9947
  • Fax: 678-247-7858
Mailing address:
  • Phone: 800-920-9947
  • Fax: 678-247-7858

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: DR. DALE MAYFIELD
Title or Position: PRESIDENT
Credential: DMD
Phone: 770-916-5036