Provider Demographics
NPI:1396848438
Name:NATIVI, ETHEL MARIA (RDH)
Entity Type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:MARIA
Last Name:NATIVI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:ETHEL
Other - Middle Name:MARIA
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:UNIT 26610
Mailing Address - Street 2:WUERZBURG DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO AE
Mailing Address - State:NY
Mailing Address - Zip Code:09244-6610
Mailing Address - Country:US
Mailing Address - Phone:931-804-3933
Mailing Address - Fax:
Practice Address - Street 1:UNIT 26610
Practice Address - Street 2:WUERZBURG DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09244-6610
Practice Address - Country:US
Practice Address - Phone:931-804-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12345124Q00000X
VA0402203093124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered124Q00000XDental ProvidersDental Hygienist