Provider Demographics
NPI:1558354209
Name:MAURICIO, MARGARET (DDS)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
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:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33526-0232
Mailing Address - Country:US
Mailing Address - Phone:352-518-2000
Mailing Address - Fax:352-567-0218
Practice Address - Street 1:37944 PASCO AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4202
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:352-567-0218
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071144600Medicaid
FL029547796OtherMEDICAID DENTAL
FL057724300OtherMEDICAID FEE FOR SERVICE
FL029547700OtherMEDICAID FQHC