Provider Demographics
NPI:1437489291
Name:MAYES, DAVID KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEVIN
Last Name:MAYES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 S WESTERN AVE
Mailing Address - Street 2:SUITE12
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-6751
Mailing Address - Country:US
Mailing Address - Phone:773-779-0300
Mailing Address - Fax:773-779-5974
Practice Address - Street 1:9101 S WESTERN AVE
Practice Address - Street 2:SUITE12
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6751
Practice Address - Country:US
Practice Address - Phone:773-779-0300
Practice Address - Fax:773-779-5974
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190199961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice