Provider Demographics
NPI:1760732697
Name:IZARRA, MARIA ANDREINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANDREINA
Last Name:IZARRA
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 1:199 14TH ST NE
Mailing Address - Street 2:#2205
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 14TH ST NE
Practice Address - Street 2:#2205
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3643
Practice Address - Country:US
Practice Address - Phone:305-778-4954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics