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General NPI Number Information
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NPI Number | 1013549575
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Entity Type | Individual
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Provider Name | CHRISTOPHER SCOTT MAYO JR. LD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 937 CHETCO AVE STE. B
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City | BROOKINGS
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State | OR
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Zip | 97415
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Country | US
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Telephone | 541-412-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6459
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City | BROOKINGS
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State | OR
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Zip | 97415-0279
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Country | US
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Telephone | 530-310-0479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | DT-DO-10186047
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License Number State | OR
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