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General NPI Number Information
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NPI Number | 1245851559
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Entity Type | Individual
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Provider Name | WILLIAM MAYFIELD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 1437 OLD SQUARE RD # 105
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City | JACKSON
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State | MS
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Zip | 39211-5535
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Country | US
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Telephone | 601-956-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4036 OAKRIDGE DR
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City | JACKSON
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State | MS
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Zip | 39216-3413
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4238-21
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License Number State | MS
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