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General NPI Number Information
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NPI Number | 1811887334
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Entity Type | Organization
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Legal Business Name | MAYA SEDATION LLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 2062 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4002
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Country | US
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Telephone | 908-295-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 640 S MONROE ST
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City | HINSDALE
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State | IL
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Zip | 60521-3926
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Country | US
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Telephone | 908-295-3666
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Fax |
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Authorized Official
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Title or Position | DENTIST ANESTHESIOLOGIST
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Name | AMY MAYA
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Credential | DDS
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Telephone | 908-295-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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