Deverick M Mayfield, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2021025918 Issued in MO

Practice address

3750 S Lindbergh Blvd Ste 102
Saint Louis, MO 63127-1375

Phone

(217) 821-0445

NPI assigned

Jul 15, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1720650013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S PARK ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012646",
            "telephone_number": "217-821-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 S LINDBERGH BLVD STE 102",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271375",
            "telephone_number": "217-821-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYFIELD",
        "first_name": "DEVERICK",
        "middle_name": "M",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2021025918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Mayer, COTA
• Gillian Sloane Mayersohn, PSY.D., ABPP
• Angela Marie Mayes, APRN, MSN, NP-C
• D'Antay Mayes
• Erin Leeanne Mayeux, MD
• Jane Annette Mayfield
• Lakeesha Mayfield, LPN
• Mary Elizabeth Mayfield, PHARMD
• Adam P Mayhew, R.N.
• Gabrielle Maynard, NP

• General Practice Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.