Provider Demographics
NPI:1457440455
Name:CARRILLO, MARIA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:CARRILLO
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 1:1314 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7989
Mailing Address - Country:US
Mailing Address - Phone:956-316-1582
Mailing Address - Fax:956-380-1176
Practice Address - Street 1:1314 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7989
Practice Address - Country:US
Practice Address - Phone:956-316-1582
Practice Address - Fax:956-380-1176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB15967-1OtherCHIP DENTAL SERVICES
TX156783601Medicaid