Organization
MAVIS NG DMD COMPREHENSIVE DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAVIS NG DMD (DOCTOR)
(604) 257-2322
Entity
Organization
Contact information
Practice address
840 HANSHAW RD STE 14, ITHACA, NY 14850-1589
(607) 257-2322
Mailing address
840 HANSHAW RD STE 14, ITHACA, NY 14850-1589
(607) 257-2322
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
06/07/2023
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