Individual
DR. ERIC J MAYUGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
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
MO
01
—
383059
BCBS OF KS
KS
Enumeration date
08/07/2007
Last updated
08/07/2007
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