1295095198 NPI number — DR. HOLLY VIRGINIA MAYHER D.D.S.

Table of content: DR. HOLLY VIRGINIA MAYHER D.D.S. (NPI 1295095198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295095198 NPI number — DR. HOLLY VIRGINIA MAYHER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYHER
Provider First Name:
HOLLY
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAYHER
Provider Other First Name:
HOLLY
Provider Other Middle Name:
GUARD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295095198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 RIDGELY AVE STE 22A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-268-5751
Provider Business Mailing Address Fax Number:
410-267-7044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 RIDGELY AVE STE 22A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-268-5751
Provider Business Practice Location Address Fax Number:
410-267-7044
Provider Enumeration Date:
05/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12213 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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