Provider Demographics
NPI:1588759047
Name:MAYS, MARK J (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:MAYS
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:11382 PROSPERITY FARMS ROAD SUITE 129
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-622-9601
Mailing Address - Fax:561-691-9565
Practice Address - Street 1:11382 PROSPERITY FARMS ROAD SUITE 129
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-622-9601
Practice Address - Fax:561-691-9565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL85731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL077500200Medicaid