Provider Demographics
NPI:1477697464
Name:FACET, MATILDE EUGENIA (DDS,)
Entity Type:Individual
Prefix:DR
First Name:MATILDE
Middle Name:EUGENIA
Last Name:FACET
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 1:9093 RIDGEFIELD DR
Mailing Address - Street 2:SUITE #203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6710
Mailing Address - Country:US
Mailing Address - Phone:301-624-1001
Mailing Address - Fax:301-624-1016
Practice Address - Street 1:9093 RIDGEFIELD DR
Practice Address - Street 2:SUITE #203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6710
Practice Address - Country:US
Practice Address - Phone:301-624-1001
Practice Address - Fax:301-624-1016
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD128731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01385660OtherUNITED CONCORDIA