# JERRY G. MAYES, PSC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** London Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124158894
- **Authorized official:** MR. JERRY MAYES DMD (OWNER DENTIST GENERAL)
- **Authorized official phone:** (606) 878-7251

## Contact information

- **Practice address:** 828 SOUTH MAIN STREET, LONDON, KY 40741
- **Practice address phone:** (606) 878-7251
- **Practice address fax:** (606) 878-1285
- **Mailing address:** 828 SOUTH MAIN STREET, LONDON, KY 40741
- **Mailing address phone:** (606) 878-7251
- **Mailing address fax:** (606) 878-1285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 08/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 45000395 | EPSDT | KY |
| 05 | — | 61900593 | — | KY |