Provider Demographics
NPI:1144668252
Name:ATAYDE, MARANATHA M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARANATHA
Middle Name:M
Last Name:ATAYDE
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 1:13626 WARWICK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-5566
Mailing Address - Country:US
Mailing Address - Phone:757-833-7217
Mailing Address - Fax:757-833-0134
Practice Address - Street 1:13626 WARWICK BLVD STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-5566
Practice Address - Country:US
Practice Address - Phone:757-833-7217
Practice Address - Fax:757-833-0134
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014147651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice