Mavis Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MAVIS DENTAL

Practice address

4805 Lake Brook Dr Ste 150
Glen Allen, VA 23060-9278

Phone

(804) 396-1213

NPI assigned

Sep 14, 2026

Organization subpart

No

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

Authorized official

Name

Dr. Davis Wayne Gardner, DDS

Title

Owner/Doctor

Phone

(804) 396-1213

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1789344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1861303646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 LAKE BROOK DR STE 150",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230609278",
            "telephone_number": "804-396-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 LAKE BROOK DR STE 150",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230609278",
            "telephone_number": "804-396-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVIS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-14",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-11",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "DAVIS",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "804-396-1213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Elise Massey, M.ED.
• Stephanie Rene Matsko, O.D.
• Matthew R. Brokaw, D.D.S., P.C.
• Loring Tyler Matthews, PHD
• Maven Mental Health Billing & Consulting, LLC
• Maxim Healthcare Services, Inc.
• Shaunna R Mayers, PT
• Geraldine Mbonefor
• Ashley Lynn McAllister, MS, LAT, ATC
• James Martin McCabe, LCSW

• Dental Clinic/Center in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Dental Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.