Provider Demographics
NPI:1780114660
Name:MESQUITA, MARIA CRISTINA (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CRISTINA
Last Name:MESQUITA
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 1:23 LAKESHORE DR APT H9
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2996
Mailing Address - Country:US
Mailing Address - Phone:508-451-9811
Mailing Address - Fax:
Practice Address - Street 1:116 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3811
Practice Address - Country:US
Practice Address - Phone:508-485-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18575761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty