Organization
DERRICK MAYO LLC
Active
Other names
614 Dental group
Organization subpart
No
Provider details
NPI number
Authorized official
TARA POLIZZI (OFFICE MANAGER)
(614) 588-8200
Entity
Organization
Contact information
Practice address
81 S 4TH ST STE 205, COLUMBUS, OH 43215-4308
(614) 588-8200
Mailing address
81 S 4TH ST STE 205, COLUMBUS, OH 43215-4308
(614) 588-8200
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
01/16/2025
Last updated
01/17/2025
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