Provider Demographics
NPI:1811053929
Name:DIMATERA, MARIA LOURDES BRIZ (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA LOURDES
Middle Name:BRIZ
Last Name:DIMATERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-3115
Mailing Address - Country:US
Mailing Address - Phone:559-876-1777
Mailing Address - Fax:559-876-2763
Practice Address - Street 1:801 N ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-3115
Practice Address - Country:US
Practice Address - Phone:559-876-1777
Practice Address - Fax:559-876-2763
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD44862OtherRENDERING PROVIDER NUMBER
CA44862OtherRENDERING PROVIDER NUMBER