Provider Demographics
NPI:1003577230
Name:BLACKSHAW, MARITZA (RDH)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:BLACKSHAW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870 WOODLAND CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2409
Mailing Address - Country:US
Mailing Address - Phone:386-241-5185
Mailing Address - Fax:
Practice Address - Street 1:7870 WOODLAND CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2409
Practice Address - Country:US
Practice Address - Phone:386-241-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH10530124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist