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General NPI Number Information
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NPI Number | 1760760367
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Entity Type | Organization
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Legal Business Name | MAYO DENTAL LLC
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Dates
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Enumeration Date | 07/30/2011
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 55 MAYO RD STE 1
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City | EDGEWATER
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State | MD
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Zip | 21037-1805
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Country | US
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Telephone | 410-956-6626
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Fax | 877-310-6316
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Provider Business Mailing Address
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Address Line | 55 MAYO RD STE 1
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City | EDGEWATER
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State | MD
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Zip | 21037-1805
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Country | US
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Telephone | 410-956-6626
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Fax | 877-310-6316
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Authorized Official
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Title or Position | DENTAL PROVIDER
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Name | DR. PUNEETA KEER
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Credential | D.M.D.
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Telephone | 410-956-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 13264
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License Number State | MD
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