Provider Demographics
NPI:1821279548
Name:AUSTRIA, MARIA DOLORES CHUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA DOLORES
Middle Name:CHUA
Last Name:AUSTRIA
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 1:1902 LARCH ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2408
Mailing Address - Country:US
Mailing Address - Phone:805-526-6065
Mailing Address - Fax:
Practice Address - Street 1:1902 LARCH ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2408
Practice Address - Country:US
Practice Address - Phone:805-526-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice