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General NPI Number Information
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NPI Number | 1831366848
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Entity Type | Organization
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Legal Business Name | TOMMY L. MAYHUE D.D.S.
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 1119 N COUNCIL AVE
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City | BLANCHARD
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State | OK
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Zip | 73010-8037
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Country | US
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Telephone | 405-485-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 575
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City | BLANCHARD
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State | OK
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Zip | 73010-0575
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Country | US
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Telephone | 405-485-2020
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Fax |
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | DR. TOMMY LEO MAYHUE
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Credential | D.D.S.
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Telephone | 405-485-2020
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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 | 4419
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License Number State | OK
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