Provider Demographics
NPI:1386866267
Name:UPSHAW, MARIA ANTONIA (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONIA
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ANTONIA
Other - Last Name:EGUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 E KENNEDY BLVD
Mailing Address - Street 2:STE 1425
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5864
Mailing Address - Country:US
Mailing Address - Phone:813-229-8090
Mailing Address - Fax:813-229-8090
Practice Address - Street 1:201 E KENNEDY BLVD
Practice Address - Street 2:SUITE 1425
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5181
Practice Address - Country:US
Practice Address - Phone:813-229-8090
Practice Address - Fax:813-224-0009
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist