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Organization
ERIC J MAYUGA DDS PA
Active
Organization
ERIC J MAYUGA DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC J MAYUGA DDS (OWNER)
(913) 856-6171
Entity
Organization
Contact information
Practice address
204 E MAIN ST, GARDNER, KS 66030
(913) 856-6171
(913) 884-6151
Mailing address
PO BOX 271, 204 E MAIN ST, GARDNER, KS 66030
(913) 856-6171
(913) 884-6151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7031
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23931023
BCBS OF KC
—
01
—
383059
BCBS OF KS
—
Enumeration date
11/01/2006
Last updated
05/16/2011
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