Provider Demographics
NPI:1902038623
Name:LARIOS, MAURICIO G (DDS)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:G
Last Name:LARIOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E SAN YSIDRO BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3123
Mailing Address - Country:US
Mailing Address - Phone:619-831-0437
Mailing Address - Fax:619-785-3404
Practice Address - Street 1:1109 E 8TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-3012
Practice Address - Country:US
Practice Address - Phone:619-831-0437
Practice Address - Fax:619-785-3404
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ28949851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice