| Doctor Name: | MRS. KISMET MAYO |
| NPI Number: | 1053697201 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DENTURIST |
| License Number: | DT-DO-10131106 |
| Business Practice Address: | 1041 Chetco Ave Brookings, OR - 974157153 |
| Business Phone Number: | 5414128000 |
| Business Fax Number: | |
| Mailing Address: | Po Box 6459, BROOKINGS |
| State: | OR |
| Postal Code: | 974150279 |
| Phone Number: | 5414128000 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2011 |
| NPI Last Update Date: | 11/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DT-DO-10131106 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |