Individual
MAYA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6438 WILMINGTON PIKE STE 205, DAYTON, OH 45459-7023
(937) 848-5986
Mailing address
4516 ALABAMA AVE, COLUMBUS, MS 39705-7505
(509) 885-4253
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH.002025925
CO
Other
Enumeration date
01/21/2025
Last updated
01/21/2025
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