Provider Demographics
NPI:1336216175
Name:SHORT, MAUREEN T (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:T
Last Name:SHORT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:646 N DIAMOND BAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1037
Mailing Address - Country:US
Mailing Address - Phone:909-861-2661
Mailing Address - Fax:909-861-6951
Practice Address - Street 1:646 N DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1037
Practice Address - Country:US
Practice Address - Phone:909-861-2661
Practice Address - Fax:909-861-6951
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA326621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry