Provider Demographics
NPI:1295036382
Name:URIARTE, MARICELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARICELA
Middle Name:
Last Name:URIARTE
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 1:8875 LA MESA BLVD SUIT
Mailing Address - Street 2:SUIT E
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-1226
Mailing Address - Country:US
Mailing Address - Phone:619-247-8004
Mailing Address - Fax:
Practice Address - Street 1:8875 LA MESA BLVD
Practice Address - Street 2:SUIT E
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5434
Practice Address - Country:US
Practice Address - Phone:619-247-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist