Provider Demographics
NPI:1215144696
Name:MAYER, MICHAEL S (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:MAYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 FAIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1237
Mailing Address - Country:US
Mailing Address - Phone:585-383-9220
Mailing Address - Fax:
Practice Address - Street 1:1157 FAIRPORT RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1237
Practice Address - Country:US
Practice Address - Phone:585-383-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0440151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice