Provider Demographics
NPI:1629284864
Name:ZECCA-BOTWIN, MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:ZECCA-BOTWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8188 JOG RD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2952
Mailing Address - Country:US
Mailing Address - Phone:561-733-0004
Mailing Address - Fax:561-733-9393
Practice Address - Street 1:8188 JOG RD
Practice Address - Street 2:SUITE #104
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2952
Practice Address - Country:US
Practice Address - Phone:561-733-0004
Practice Address - Fax:561-733-9393
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice