Individual
MRS. KISMET MAYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DENTURIST
Contact information
Practice address
1041 CHETCO AVE, BROOKINGS, OR 97415-7153
(541) 412-8000
Mailing address
PO BOX 6459, BROOKINGS, OR 97415-0279
(541) 412-8000
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-10131106
OR
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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