Individual
JORDAN MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
73 SPORTSMAN DR STE A, MARENGO, OH 43334
(419) 253-3100
Mailing address
305 E 1ST AVE, COLUMBUS, OH 43215-2181
(740) 238-1319
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30.025048
OH
Other
Enumeration date
04/17/2017
Last updated
11/09/2018
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