Provider Demographics
NPI:1821493081
Name:CARLOS, MARIA LOURDES
Entity Type:Individual
Prefix:DR
First Name:MARIA LOURDES
Middle Name:
Last Name:CARLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARIA DE LOURDES
Other - Middle Name:
Other - Last Name:CARLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:532 N MILPAS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-3137
Mailing Address - Country:US
Mailing Address - Phone:805-884-0111
Mailing Address - Fax:805-884-1001
Practice Address - Street 1:532 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3137
Practice Address - Country:US
Practice Address - Phone:805-884-0111
Practice Address - Fax:805-884-1001
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist