MEDICARE: MAYFAIR DENTAL ASSOCIATES LTD.

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	261QD0000X	Dental Clinic/Center	DS025188L	PA

General Provider Information

NPI Number	:	1679750145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYFAIR DENTAL ASSOCIATES LTD.

Provider Business Mailing Address
First Line	:	3541 RYAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-4313
Country	:	US
Telephone Number	:	215-335-1889
Fax Number	:	215-335-1889

Provider Business Practice Location Address
First Line	:	3541 RYAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-4313
Country	:	US
Telephone Number	:	215-335-1889
Fax Number	:	215-335-1889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RALPH J KAYE
Credential	:	D.M.D
Telephone Number	:	215-335-1889

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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