# MAVIS NG DMD COMPREHENSIVE DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588356257
- **Authorized official:** MAVIS NG DMD (DOCTOR)
- **Authorized official phone:** (604) 257-2322

## Contact information

- **Practice address:** 840 HANSHAW RD STE 14, ITHACA, NY 14850-1589
- **Practice address phone:** (607) 257-2322
- **Mailing address:** 840 HANSHAW RD STE 14, ITHACA, NY 14850-1589
- **Mailing address phone:** (607) 257-2322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/22/2023
- **Last updated:** 06/07/2023