Organization
JERRY A MAYER D.M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY A MAYER DMD (ORAL SURGEON)
(740) 532-4613
Entity
Organization
Contact information
Practice address
2301 S 7TH ST, SUITE 1, IRONTON, OH 45638-2542
(740) 532-4613
(740) 532-8099
Mailing address
2301 S 7TH ST, SUITE 1, IRONTON, OH 45638-2542
(740) 532-4613
(740) 532-8099
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
19061
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0751575
—
OH
05
—
60059490
—
KY
05
—
64059496
—
KY
01
—
MAYER.JE
CARESOURCE/ OHIO MEDICAID
OH
01
—
MAYER2301
DENTAQUEST/ OHIO MEDICAID
OH
Enumeration date
01/18/2011
Last updated
01/18/2011
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