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General NPI Number Information
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NPI Number | 1154972768
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Entity Type | Organization
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Legal Business Name | DAVID K MAYES D.D.S L.T.D.
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 9101 S WESTERN AVE # 2NDFL
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City | CHICAGO
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State | IL
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Zip | 60643-6751
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Country | US
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Telephone | 773-779-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 S WESTERN AVE STE 12
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City | CHICAGO
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State | IL
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Zip | 60643-6751
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID KEVIN MAYES
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Credential | DDS
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Telephone | 773-779-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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