Provider Demographics
NPI:1255361143
Name:FUENTES, MARIA ANGELES (PEDODONTIST)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANGELES
Last Name:FUENTES
Suffix:
Gender:F
Credentials:PEDODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5701
Mailing Address - Country:US
Mailing Address - Phone:972-416-7000
Mailing Address - Fax:972-416-7007
Practice Address - Street 1:2001 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5701
Practice Address - Country:US
Practice Address - Phone:972-416-7000
Practice Address - Fax:972-416-7000
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868226OtherAHCCCS