Provider Demographics
NPI:1861762569
Name:MICHAEL T. MAYO, D.D.S.,P.C.
Entity type:Organization
Organization Name:MICHAEL T. MAYO, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RABAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-326-2420
Mailing Address - Street 1:1505 N. SWAN RD.
Mailing Address - Street 2:STE. A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4000
Mailing Address - Country:US
Mailing Address - Phone:520-326-2420
Mailing Address - Fax:520-326-2414
Practice Address - Street 1:1505 N SWAN RD
Practice Address - Street 2:STE. A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4078
Practice Address - Country:US
Practice Address - Phone:520-326-2420
Practice Address - Fax:520-326-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1906/G27561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty