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General NPI Number Information
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NPI Number | 1558465880
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Entity Type | Individual
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Provider Name | MAYA EYDELMAN DMD
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Gender | Female
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 3504 BERING DRIVE
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City | SAN BRUNO
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State | CA
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Zip | 94066-4575
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Country | US
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Telephone | 347-256-2208
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Fax |
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Provider Business Mailing Address
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Address Line | 3504 BERING DR
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City | SAN BRUNO
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State | CA
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Zip | 94066-4575
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Country | US
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Telephone | 347-256-2208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 049447
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02157000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 57852
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License Number State | CA
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