Provider Demographics
NPI:1477036267
Name:ZEIBERG, MAYA MARKOVNA (RDH, MSDH)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:MARKOVNA
Last Name:ZEIBERG
Suffix:
Gender:F
Credentials:RDH, MSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HARTWELL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1909
Mailing Address - Country:US
Mailing Address - Phone:860-874-5200
Mailing Address - Fax:
Practice Address - Street 1:2279 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1007
Practice Address - Country:US
Practice Address - Phone:860-874-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006004124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist