Provider Demographics
NPI:1790046233
Name:MAYA, MARTIN ABRAHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ABRAHAM
Last Name:MAYA
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 1:145 PALM BAY RD NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8601
Mailing Address - Country:US
Mailing Address - Phone:321-728-8053
Mailing Address - Fax:
Practice Address - Street 1:145 PALM BAY RD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8601
Practice Address - Country:US
Practice Address - Phone:321-728-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20090122300000X
OHRES. 2931122300000X
OH23796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist