Provider Demographics
NPI:1376034074
Name:MALDONADO, DIEGO EMILIO (DDS)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:EMILIO
Last Name:MALDONADO
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 1:7810 WORMANS MILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3038
Mailing Address - Country:US
Mailing Address - Phone:301-378-2595
Mailing Address - Fax:
Practice Address - Street 1:7810 WORMANS MILL RD STE D
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3038
Practice Address - Country:US
Practice Address - Phone:301-378-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD166041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice