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General NPI Number Information
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NPI Number | 1871942656
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Entity Type | Individual
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Provider Name | MACY MAI D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3751 N MAIN ST STE D
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City | ROSWELL
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State | NM
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Zip | 88201-0300
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Country | US
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Telephone | 575-622-5835
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Fax |
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Provider Business Mailing Address
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Address Line | 16798 SUMMIT VISTA DR
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City | SAN DIEGO
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State | CA
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Zip | 92127-3434
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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 | 100466
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS040871
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD4662
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License Number State | NM
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