Provider Demographics
NPI:1053410902
Name:MAYO, RYAN C (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:MAYO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice