Provider Demographics
NPI:1457572182
Name:MARCIAL-AYROSO, MARIA CONSUELO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CONSUELO
Last Name:MARCIAL-AYROSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:CONSUELO
Other - Last Name:MARCIAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:16411 CROCHERON AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2015
Mailing Address - Country:US
Mailing Address - Phone:718-353-1309
Mailing Address - Fax:718-353-4417
Practice Address - Street 1:16411 CROCHERON AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2015
Practice Address - Country:US
Practice Address - Phone:718-353-1309
Practice Address - Fax:718-353-4417
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0473181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice