Provider Demographics
NPI:1699064550
Name:MAYA A. VERNON, DDS, LLC
Entity type:Organization
Organization Name:MAYA A. VERNON, DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:ALQUEZA
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-544-4888
Mailing Address - Street 1:900 RITCHIE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4142
Mailing Address - Country:US
Mailing Address - Phone:410-544-4888
Mailing Address - Fax:
Practice Address - Street 1:900 RITCHIE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4142
Practice Address - Country:US
Practice Address - Phone:410-544-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty