Provider Demographics
NPI:1588356257
Name:MAVIS NG DMD COMPREHENSIVE DENTISTRY PLLC
Entity type:Organization
Organization Name:MAVIS NG DMD COMPREHENSIVE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:604-257-2322
Mailing Address - Street 1:840 HANSHAW RD STE 14
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1589
Mailing Address - Country:US
Mailing Address - Phone:607-257-2322
Mailing Address - Fax:
Practice Address - Street 1:840 HANSHAW RD STE 14
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1589
Practice Address - Country:US
Practice Address - Phone:607-257-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty