Provider Demographics
NPI:1760588925
Name:AQUINO, MARY FELICITY T (DMD)
Entity Type:Individual
Prefix:
First Name:MARY FELICITY
Middle Name:T
Last Name:AQUINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 VALLEY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4134
Mailing Address - Country:US
Mailing Address - Phone:626-271-0128
Mailing Address - Fax:626-369-3844
Practice Address - Street 1:119 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4711
Practice Address - Country:US
Practice Address - Phone:626-369-7373
Practice Address - Fax:626-369-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45085OtherSOUTHWEST ADMIN.
CA45085OtherTHE GUARDIAN
CA45085OtherDENTAL HEALTH SERVICES
CA45085OtherDELTA DENTAL
CA45085OtherHELLER & ASSOCIATES
CA45085OtherS. CA IBEW-NECA TRUST
CA45085OtherBLUE CROSS
CA45085OtherBLUE SHIELD
CA45085OtherSAFEGUARD PPO
CA45085OtherMETLIFE DENTAL
CA45085OtherCIGNA DENTAL
CA45085OtherSOUTHWEST CARPENTERS
CA45085OtherPRINCIPAL PLAN DENTAL
CA45085OtherUNITED CONCORDIA
CA458085OtherGREATWEST HEALTHCARE
CAB45085-01OtherDELTA DENTAL HEALTHY FAMI
CA45085OtherHARRINGTON BENEFITS SERVI
CA45085OtherAETNA DENTAL
CAB45085-01Medicaid
CAFHC70768FMedicaid