Provider Demographics
NPI:1588741490
Name:J GREGORY MAYES DDS & LISA H MAYES DDS PA
Entity type:Organization
Organization Name:J GREGORY MAYES DDS & LISA H MAYES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-460-0963
Mailing Address - Street 1:3761 NW CARY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8438
Mailing Address - Country:US
Mailing Address - Phone:919-460-0963
Mailing Address - Fax:919-319-1385
Practice Address - Street 1:3761 NW CARY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8438
Practice Address - Country:US
Practice Address - Phone:919-460-0963
Practice Address - Fax:919-319-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57141223G0001X
NC57321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7443190001Medicare NSC