Provider Demographics
NPI:1659828705
Name:MARIA M. EGUSQUIZA DMD PA
Entity Type:Organization
Organization Name:MARIA M. EGUSQUIZA DMD PA
Other - Org Name:COSMETIC DA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EGUSQUIZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-965-0292
Mailing Address - Street 1:3676 COLLIN DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4727
Mailing Address - Country:US
Mailing Address - Phone:561-965-0292
Mailing Address - Fax:561-965-0256
Practice Address - Street 1:3676 COLLIN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4727
Practice Address - Country:US
Practice Address - Phone:561-965-0292
Practice Address - Fax:561-965-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00123141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty