Provider Demographics
NPI:1699850636
Name:ADDONIZIO, MARY KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHLEEN
Last Name:ADDONIZIO
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 1:26932 OSO PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5815
Mailing Address - Country:US
Mailing Address - Phone:949-582-2325
Mailing Address - Fax:949-582-8631
Practice Address - Street 1:26932 OSO PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5815
Practice Address - Country:US
Practice Address - Phone:949-582-2325
Practice Address - Fax:949-582-8631
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist