Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 030010-L | PA |
NPI | 1073685426 |
---|---|
Provider Name | Dr. David J. Mayberry |
First Address | Mcmurray, PA 15317-2571 |
Second Address | Mcmurray, PA 15317-2571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |