Provider Demographics
NPI:1730663253
Name:POWELL, MARIA (RDH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MARQUINA
Other - Middle Name:SINSAY
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 E MERRITT ISLAND CSWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3514
Mailing Address - Country:US
Mailing Address - Phone:321-505-8869
Mailing Address - Fax:
Practice Address - Street 1:800 E MERRITT ISLAND CSWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3514
Practice Address - Country:US
Practice Address - Phone:321-453-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26321124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist