Provider Demographics
NPI:1659585990
Name:ACEBO, MARIA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:ACEBO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9904 57TH AVE
Mailing Address - Street 2:SUITE LH
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3746
Mailing Address - Country:US
Mailing Address - Phone:718-760-0471
Mailing Address - Fax:718-760-4739
Practice Address - Street 1:9904 57TH AVE
Practice Address - Street 2:SUITE LH
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3746
Practice Address - Country:US
Practice Address - Phone:718-760-0471
Practice Address - Fax:718-760-4739
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043870-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01288086Medicaid