1780711432 NPI number — GERARDO F. MAYMI, D.M.D. PC

Table of content: (NPI 1780711432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780711432 NPI number — GERARDO F. MAYMI, D.M.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERARDO F. MAYMI, D.M.D. PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JERRY F. MAYMI & ASSOCIATES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780711432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2651 W SOUTH JORDAN PKWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-8953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-253-7553
Provider Business Mailing Address Fax Number:
801-253-7553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2651 W SOUTH JORDAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84095-8953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-253-7553
Provider Business Practice Location Address Fax Number:
801-253-7553
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MMI
Authorized Official First Name:
GERARDO
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-253-7553

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  145148 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 6229900 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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