Provider Demographics
NPI:1225108517
Name:ELIZONDO, MARIA LUISA (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LUISA
Other - Last Name:ELIZONDO MARINESCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:370 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776
Mailing Address - Country:US
Mailing Address - Phone:978-443-5193
Mailing Address - Fax:978-443-4063
Practice Address - Street 1:370 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776
Practice Address - Country:US
Practice Address - Phone:978-443-5193
Practice Address - Fax:978-443-4063
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice