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General NPI Number Information
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NPI Number | 1750686077
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Entity Type | Organization
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Legal Business Name | JERRY A MAYER D.M.D., LLC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 2301 S 7TH ST SUITE 1
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City | IRONTON
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State | OH
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Zip | 45638-2542
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Country | US
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Telephone | 740-532-4613
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Fax | 740-532-8099
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Provider Business Mailing Address
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Address Line | 2301 S 7TH ST SUITE 1
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City | IRONTON
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State | OH
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Zip | 45638-2542
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Country | US
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Telephone | 740-532-4613
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Fax | 740-532-8099
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. JERRY A MAYER
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Credential | DMD
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Telephone | 740-532-4613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19061
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License Number State | OH
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