MEDICARE: RYAN C. MAYO, D.D.S & GREGORY C. MAYO D.D.S., P.C.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1871968255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN C. MAYO, D.D.S & GREGORY C. MAYO D.D.S., P.C.

Provider Business Mailing Address
First Line	:	22 DAVIS AVE SW
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-3824
Country	:	US
Telephone Number	:	703-777-3510
Fax Number	:	703-777-9488

Provider Business Practice Location Address
First Line	:	22 DAVIS AVE SW
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-3824
Country	:	US
Telephone Number	:	703-777-3510
Fax Number	:	703-777-9488

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. GREGORY C MAYO
Credential	:	D.D.S.
Telephone Number	:	703-777-3510

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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