# ERIC J MAYUGA DDS PA

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

## Provider details

- **NPI number:** 1912084914
- **Authorized official:** ERIC J MAYUGA DDS (OWNER)
- **Authorized official phone:** (913) 856-6171

## Contact information

- **Practice address:** 204 E MAIN ST, GARDNER, KS 66030
- **Practice address phone:** (913) 856-6171
- **Practice address fax:** (913) 884-6151
- **Mailing address:** PO BOX 271, 204 E MAIN ST, GARDNER, KS 66030
- **Mailing address phone:** (913) 856-6171
- **Mailing address fax:** (913) 884-6151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7031 | KS | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 05/16/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 23931023 | BCBS OF KC | — |
| 01 | — | 383059 | BCBS OF KS | — |