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General NPI Number Information
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NPI Number | 1861762569
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Entity Type | Organization
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Legal Business Name | MICHAEL T. MAYO, D.D.S.,P.C.
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 1505 N SWAN RD STE. A
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City | TUCSON
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State | AZ
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Zip | 85712-4078
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Country | US
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Telephone | 520-326-2420
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Fax | 520-326-2414
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Provider Business Mailing Address
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Address Line | 1505 N. SWAN RD. STE. A
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City | TUCSON
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State | AZ
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Zip | 85712-4000
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Country | US
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Telephone | 520-326-2420
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Fax | 520-326-2414
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Authorized Official
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Title or Position | FRONT OFFICE
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Name | MELISSA A RABAGO
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Credential |
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Telephone | 520-326-2420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1906/G2756
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License Number State | AZ
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