Healthcare Provider Details

I. General information

NPI: 1881582740
Provider Name (Legal Business Name): MAYA YASSIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13869 W BELL RD
SURPRISE AZ
85374-2468
US

IV. Provider business mailing address

4239 E COOLBROOK AVE
PHOENIX AZ
85032-9211
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-4015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012507
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012507
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: