Provider Demographics
NPI:1558670737
Name:NUNLEY, MAYA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:R
Last Name:NUNLEY
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:WSU AEGD PROGRAM
Mailing Address - Street 2:1845 FAIRMOUNT
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0001
Mailing Address - Country:US
Mailing Address - Phone:319-978-3456
Mailing Address - Fax:
Practice Address - Street 1:GRACE MED CLINIC 1122 N. TOPEKA
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214
Practice Address - Country:US
Practice Address - Phone:316-866-2000
Practice Address - Fax:316-866-2082
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist