Provider Demographics
NPI:1093705352
Name:NUNEZ, MARITZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:NUNEZ
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 1:3448 93RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3744
Mailing Address - Country:US
Mailing Address - Phone:718-565-6740
Mailing Address - Fax:718-335-9834
Practice Address - Street 1:3448 93RD ST
Practice Address - Street 2:
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3744
Practice Address - Country:US
Practice Address - Phone:718-565-6740
Practice Address - Fax:718-335-9834
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0432691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01234573Medicaid