Provider Demographics
NPI:1770039125
Name:WHEARTY, MAYA ANNE (RDH;RDHAP)
Entity type:Individual
Prefix:MISS
First Name:MAYA
Middle Name:ANNE
Last Name:WHEARTY
Suffix:
Gender:F
Credentials:RDH;RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SERRANO DR
Mailing Address - Street 2:APT 1A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-2276
Mailing Address - Country:US
Mailing Address - Phone:415-652-1677
Mailing Address - Fax:
Practice Address - Street 1:1321 S ELISEO DR
Practice Address - Street 2:DR. WRIGHT SUITE
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2024
Practice Address - Country:US
Practice Address - Phone:415-652-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA632124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist