Provider Demographics
NPI:1053489138
Name:EUSEBIO, CLARINDA CARAG (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLARINDA
Middle Name:CARAG
Last Name:EUSEBIO
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:VIA BERRETTA ROSSA 20
Mailing Address - Street 2:
Mailing Address - City:BOLOGNA
Mailing Address - State:BO
Mailing Address - Zip Code:40133
Mailing Address - Country:IT
Mailing Address - Phone:39340-340-4932
Mailing Address - Fax:
Practice Address - Street 1:VIA BERRETTA ROSSA 20
Practice Address - Street 2:
Practice Address - City:BOLOGNA
Practice Address - State:BO
Practice Address - Zip Code:40133
Practice Address - Country:IT
Practice Address - Phone:39340-340-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist