Provider Demographics
NPI:1215168588
Name:R.E. MAYER, D.D.S., P.C.
Entity type:Organization
Organization Name:R.E. MAYER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLF
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-693-4171
Mailing Address - Street 1:15141 E. WHITTIER BLVD.
Mailing Address - Street 2:SUITE 255
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603
Mailing Address - Country:US
Mailing Address - Phone:562-693-4171
Mailing Address - Fax:562-698-7827
Practice Address - Street 1:15141 E. WHITTIER BLVD.
Practice Address - Street 2:SUITE 255
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603
Practice Address - Country:US
Practice Address - Phone:562-693-4171
Practice Address - Fax:562-698-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD313241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-93402-02OtherDENTI-CAL