Jordan Mayberry, DDS is a medicare enrolled "Dentist - General Practice" provider in Marengo, Ohio. His current practice location is
73 Sportsman Dr Ste A, Marengo, Ohio. You can reach out to his office (for appointments etc.) via phone at
(419) 253-3100.
Jordan Mayberry is licensed to practice in Ohio (license number 30.025048) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1073047049.
Healthcare Provider's Profile
Full Name | Jordan Mayberry |
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Gender | Male |
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Speciality | Dentist - General Practice |
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Location | 73 Sportsman Dr Ste A, Marengo, Ohio |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1073047049
- Provider Enumeration Date: 04/17/2017
- Last Update Date: 11/09/2018
Medicare PECOS Information:
- PECOS PAC ID: 8022382704
- Enrollment ID: I20170919002058
Medical Identifiers
Medical identifiers for Jordan Mayberry such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1073047049 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
1223G0001X | Dentist - General Practice | 30.025048 (Ohio) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jordan Mayberry is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jordan Mayberry, DDS 305 E 1st Ave, Columbus, OH 43215-2181 Ph: (740) 238-1319 | Jordan Mayberry, DDS 73 Sportsman Dr Ste A, Marengo, OH 43334 Ph: (419) 253-3100 |
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