Provider Demographics
NPI:1730399965
Name:MAA, JANE P (DDS)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:P
Last Name:MAA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-2617
Mailing Address - Country:US
Mailing Address - Phone:847-835-3200
Mailing Address - Fax:
Practice Address - Street 1:650 VERNON AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-2617
Practice Address - Country:US
Practice Address - Phone:847-835-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist