MEDICARE: MAYFLOWER ORAL AND MAXILLOFACIAL SURGERY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN1855112	MA

General Provider Information

NPI Number	:	1538391214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYFLOWER ORAL AND MAXILLOFACIAL SURGERY PLLC

Provider Business Mailing Address
First Line	:	675 PARAMOUNT DR
Second Line	:	SUITE 105
City	:	RAYNHAM
State	:	MA
Zip	:	02767-5416
Country	:	US
Telephone Number	:	405-848-7974
Fax Number	:	405-848-0033

Provider Business Practice Location Address
First Line	:	5600 N MAY AVE
Second Line	:	SUITE 250
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3973
Country	:	US
Telephone Number	:	405-848-7974
Fax Number	:	405-848-0033

Authorized Official
Title or Position	:	ORAL SURGEON
Name	:	DR. NICHOLAS C VEGA
Credential	:	DDS
Telephone Number	:	405-848-7974

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	08/14/2009

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