Provider Demographics
NPI:1104815562
Name:MAYER, CARL ERIC (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ERIC
Last Name:MAYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60071-9672
Mailing Address - Country:US
Mailing Address - Phone:815-678-4644
Mailing Address - Fax:847-526-7385
Practice Address - Street 1:121 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1929
Practice Address - Country:US
Practice Address - Phone:847-526-7383
Practice Address - Fax:847-526-7385
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist