Provider Demographics
NPI:1871349548
Name:MAYFAIR DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MAYFAIR DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BATRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-640-8277
Mailing Address - Street 1:118 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-3900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6412 FRANKFORD AVE STE 10
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3005
Practice Address - Country:US
Practice Address - Phone:215-333-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental