Provider Demographics
NPI:1467732552
Name:MAURICIO, JESSICA SUZANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SUZANNE
Last Name:MAURICIO
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 1:5005 N PIEDRAS ST
Mailing Address - Street 2:DENTAC
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-744-6083
Mailing Address - Fax:915-744-2027
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:DENTAC
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-744-6083
Practice Address - Fax:915-744-2027
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice