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General NPI Number Information
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NPI Number | 1902297542
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Entity Type | Organization
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Legal Business Name | ELISHA MAYES, DDS, PC
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 1502 N PINE ST SUITE 2
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City | LA GRANDE
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State | OR
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Zip | 97850-3543
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Country | US
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Telephone | 541-963-8585
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Fax | 541-963-6633
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Provider Business Mailing Address
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Address Line | 1502 N PINE ST SUITE 2
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City | LA GRANDE
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State | OR
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Zip | 97850-3543
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Country | US
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Telephone | 541-963-8585
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Fax | 541-963-6633
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. SHANTAY SABIN MAYES
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Credential |
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Telephone | 303-229-0004
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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 | 9190
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License Number State | OR
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