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General NPI Number Information
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NPI Number | 1740544972
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Entity Type | Individual
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Provider Name | TONI-ANN HYLTON MAYEMBE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 5149 NORMANDY BLVD UNIT 4
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City | JACKSONVILLE
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State | FL
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Zip | 32205-4861
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Country | US
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Telephone | 904-781-1201
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Fax |
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Provider Business Mailing Address
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Address Line | 926 GREAT POND DR STE 2002
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7244
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN19788
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License Number State | FL
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