Provider Demographics
NPI:1679669105
Name:DEMAS, MARIA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:DEMAS
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 1:2818 MULFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-6623
Mailing Address - Country:US
Mailing Address - Phone:407-629-0526
Mailing Address - Fax:
Practice Address - Street 1:832 W. CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-836-2617
Practice Address - Fax:407-836-2699
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN98391223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010519300Medicaid
FL072000300Medicaid