Basic Information
Provider Information
NPI: 1659711497
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEEL
FirstName: MAYA
MiddleName: DEVIN
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 206 W 6TH AVE
Address2:  
City: STILLWATER
State: OK
PostalCode: 740744017
CountryCode: US
TelephoneNumber: 4057070600
FaxNumber:  
Practice Location
Address1: 1810 E HIGHLAND DR
Address2:  
City: JONESBORO
State: AR
PostalCode: 724016117
CountryCode: US
TelephoneNumber: 8702393948
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/25/2013
LastUpdateDate: 06/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X3945ARY Dental ProvidersDentist 

No ID Information.


Home