Provider Demographics
NPI:1154972768
Name:DAVID K MAYES D.D.S L.T.D.
Entity type:Organization
Organization Name:DAVID K MAYES D.D.S L.T.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-779-0300
Mailing Address - Street 1:9101 S WESTERN AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-6751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9101 S WESTERN AVE # 2NDFL
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental