NPIMap

Organization Active NPI

Mayatte Family Dentistry, LLC

  • General Practice Dentistry
  • Brandon, MS
National Provider Identifier
1316154776
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MAYATTE FAMILY DENTISTRY, LLC
Practice address
22 Eastgate Dr
Brandon, MS 39042-2318
Phone
(601) 825-1105
Fax
(601) 825-1984
NPI assigned
May 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. E. Shaun Mayatte, DMD
Title
Owner
Phone
(601) 825-1105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

22 Eastgate Dr
Brandon, MS 39042-2318

Mailing address

22 Eastgate Dr
Brandon, MS 39042-2318
Phone (601) 825-1105

National Provider Directory

National Provider Directory

Locations

22 Eastgate Dr
Brandon, MS 39042
Phone (601) 825-1105

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316154776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 EASTGATE DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422318",
            "telephone_number": "601-825-1105",
            "fax_number": "601-825-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 EASTGATE DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422318",
            "telephone_number": "601-825-1105",
            "fax_number": "601-825-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYATTE FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAYATTE",
        "authorized_official_first_name": "E.",
        "authorized_official_middle_name": "SHAUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-825-1105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.