Provider Demographics
NPI:1316200751
Name:TATE, MARILIA PAIVA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARILIA
Middle Name:PAIVA
Last Name:TATE
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 1:2030 PATTON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5770
Mailing Address - Country:US
Mailing Address - Phone:205-979-9491
Mailing Address - Fax:205-979-5439
Practice Address - Street 1:2030 PATTON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5770
Practice Address - Country:US
Practice Address - Phone:205-979-9491
Practice Address - Fax:205-979-5439
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist