Provider Demographics
NPI:1427179621
Name:DITOLLA, MARIS LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:MARIS
Middle Name:LYNN
Last Name:DITOLLA
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 1:5 MORRILL PL
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3501
Mailing Address - Country:US
Mailing Address - Phone:978-388-4323
Mailing Address - Fax:978-388-9833
Practice Address - Street 1:5 MORRILL PL
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3501
Practice Address - Country:US
Practice Address - Phone:978-388-4323
Practice Address - Fax:978-388-9833
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice