Provider Demographics
NPI:1386898286
Name:MAYES, BRANDY NICOLE (RDH)
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:NICOLE
Last Name:MAYES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 NE 21ST AVE
Mailing Address - Street 2:APT 207
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1566
Mailing Address - Country:US
Mailing Address - Phone:310-497-9405
Mailing Address - Fax:
Practice Address - Street 1:1532 NE 21ST AVE
Practice Address - Street 2:APT 207
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1566
Practice Address - Country:US
Practice Address - Phone:310-497-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5352124Q00000X
WA00007926124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist