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General NPI Number Information
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NPI Number | 1306027883
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Entity Type | Organization
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Legal Business Name | STEPHEN P. MAYER, D.D.S., INC.
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 244 S SCRAPER ST
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City | VINITA
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State | OK
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Zip | 74301-3740
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Country | US
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Telephone | 918-256-6441
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Fax |
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Provider Business Mailing Address
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Address Line | 244 S SCRAPER ST
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City | VINITA
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State | OK
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Zip | 74301-3740
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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 | MANAGER
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Name | MR. BRIAN MAYER
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Credential |
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Telephone | 918-256-6441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4910
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License Number State | OK
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