Provider Demographics
NPI:1033602719
Name:DORSETT, MARIA PAK (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PAK
Last Name:DORSETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 KNOLL CREST DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6430
Mailing Address - Country:US
Mailing Address - Phone:256-694-0192
Mailing Address - Fax:
Practice Address - Street 1:114 BROOKWOOD RD E
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228-2240
Practice Address - Country:US
Practice Address - Phone:205-923-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6507122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist