Provider Demographics
NPI:1871968255
Name:RYAN C. MAYO, D.D.S & GREGORY C. MAYO D.D.S., P.C.
Entity type:Organization
Organization Name:RYAN C. MAYO, D.D.S & GREGORY C. MAYO D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-777-3510
Mailing Address - Street 1:22 DAVIS AVE SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3824
Mailing Address - Country:US
Mailing Address - Phone:703-777-3510
Mailing Address - Fax:703-777-9488
Practice Address - Street 1:22 DAVIS AVE SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3824
Practice Address - Country:US
Practice Address - Phone:703-777-3510
Practice Address - Fax:703-777-9488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty