Provider Demographics
NPI:1396899316
Name:MEZCUA, MARIA (DDS PA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:MEZCUA
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18503 PINES BLVD
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1404
Mailing Address - Country:US
Mailing Address - Phone:954-432-4101
Mailing Address - Fax:954-432-5330
Practice Address - Street 1:18503 PINES BLVD
Practice Address - Street 2:SUITE # 202
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1404
Practice Address - Country:US
Practice Address - Phone:954-432-4101
Practice Address - Fax:954-432-5330
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00131281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice