Provider Demographics
NPI:1154449098
Name:VERNON, MAYA ALQUEZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:ALQUEZA
Last Name:VERNON
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 1:900 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:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry