Provider Demographics
NPI:1124224076
Name:BAKMAN, MAYYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAYYA
Middle Name:
Last Name:BAKMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SUNSET RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4006
Mailing Address - Country:US
Mailing Address - Phone:847-272-7874
Mailing Address - Fax:
Practice Address - Street 1:821 SUNSET RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4006
Practice Address - Country:US
Practice Address - Phone:847-272-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027411122300000X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice