Healthcare Provider Details

I. General information

NPI: 1811887334
Provider Name (Legal Business Name): MAYA SEDATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2062 N MILWAUKEE AVE
CHICAGO IL
60647-4002
US

IV. Provider business mailing address

640 S MONROE ST
HINSDALE IL
60521-3926
US

V. Phone/Fax

Practice location:
  • Phone: 908-295-3666
  • Fax:
Mailing address:
  • Phone: 908-295-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: AMY MAYA
Title or Position: DENTIST ANESTHESIOLOGIST
Credential: DDS
Phone: 908-295-3666