Provider Demographics
NPI:1902468705
Name:DAMASCO, MARICHRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARICHRIS
Middle Name:
Last Name:DAMASCO
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 1:1469 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3421
Mailing Address - Country:US
Mailing Address - Phone:619-947-5593
Mailing Address - Fax:
Practice Address - Street 1:397 E ST STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2684
Practice Address - Country:US
Practice Address - Phone:619-425-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1039141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice