Derrick Mayo LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

DERRICK MAYO LLC

Doing business as

614 Dental group

Practice address

81 S 4TH St Ste 205
Columbus, OH 43215-4308

Phone

(614) 588-8200

NPI assigned

Jan 16, 2025

Organization subpart

No

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

Authorized official

Name

Tara Polizzi

Title

Office Manager

Phone

(614) 588-8200

Specialties & licenses 1

Addresses

Other names 1

• 614 Dental group Doing business as

Locations

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

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1982415154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 S 4TH ST STE 205",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432154308",
            "telephone_number": "614-588-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 S 4TH ST STE 205",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432154308",
            "telephone_number": "614-588-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRICK MAYO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "POLIZZI",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "614-588-8200"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "614 Dental group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "614 Dental group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Maud Des - Bordes

• General Practice Physician in Columbus, OH
• Providers in Columbus, OH by specialty
• General Practice Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.