Provider Demographics
NPI:1740358175
Name:LUCIA, MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:LUCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:LUCIA
Other - Last Name:BILLINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4955 W TAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4811
Mailing Address - Country:US
Mailing Address - Phone:315-461-8400
Mailing Address - Fax:315-461-0400
Practice Address - Street 1:4955 W TAFT RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4811
Practice Address - Country:US
Practice Address - Phone:315-461-8400
Practice Address - Fax:315-461-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0388651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02511200Medicaid