Provider Demographics
NPI:1407945876
Name:LIMOSNERO, MAUREEN (DDS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:LIMOSNERO
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 1:5110 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5910
Mailing Address - Country:US
Mailing Address - Phone:817-318-5600
Mailing Address - Fax:
Practice Address - Street 1:5110 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5910
Practice Address - Country:US
Practice Address - Phone:817-318-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD76811223G0001X
TX28653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181134Medicaid
911019392OtherCOMMERCIAL