Provider Demographics
NPI:1588410088
Name:DUSTIN MAYRAND DMD PLLC
Entity type:Organization
Organization Name:DUSTIN MAYRAND DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-404-3947
Mailing Address - Street 1:230 CONNECTOR RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9722
Mailing Address - Country:US
Mailing Address - Phone:502-642-5008
Mailing Address - Fax:
Practice Address - Street 1:230 CONNECTOR RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9722
Practice Address - Country:US
Practice Address - Phone:502-642-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty