Provider Demographics
NPI:1700134194
Name:SEOANE, MARITZA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:SEOANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 ALAFAYA TRL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9482
Mailing Address - Country:US
Mailing Address - Phone:407-366-2363
Mailing Address - Fax:407-366-9564
Practice Address - Street 1:2959 ALAFAYA TRL
Practice Address - Street 2:SUITE 109
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9482
Practice Address - Country:US
Practice Address - Phone:407-366-2363
Practice Address - Fax:407-366-9564
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0014220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593497864OtherTAX ID NUMBER