Provider Demographics
NPI:1790831808
Name:MAYA, JULIO (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:
Last Name:MAYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6265 E FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3304
Mailing Address - Country:US
Mailing Address - Phone:813-989-3269
Mailing Address - Fax:813-989-3174
Practice Address - Street 1:6265 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3304
Practice Address - Country:US
Practice Address - Phone:813-989-3269
Practice Address - Fax:813-989-3174
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN101091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL521414OtherUNITED CONCORDIA
FL60686OtherBLUE CROSS BLUE SHIELD