Provider Demographics
NPI:1538242128
Name:MAI, MICHAEL C (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MAI
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 1:15772 STARBOARD ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-5351
Mailing Address - Country:US
Mailing Address - Phone:714-873-3693
Mailing Address - Fax:
Practice Address - Street 1:17240 DOWNEY AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6105
Practice Address - Country:US
Practice Address - Phone:562-531-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60501223G0001X
CA449321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice