Provider Demographics
NPI:1720845019
Name:ACUZAR-BRILLANTES, SEMEONA MARQUEZ (RDH)
Entity Type:Individual
Prefix:
First Name:SEMEONA
Middle Name:MARQUEZ
Last Name:ACUZAR-BRILLANTES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9275 BISCAYNE ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-7027
Mailing Address - Country:US
Mailing Address - Phone:240-838-4064
Mailing Address - Fax:
Practice Address - Street 1:173 SAINT PATRICKS DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5529
Practice Address - Country:US
Practice Address - Phone:301-645-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD219670126800000X
MD7539124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant