Basic Information
| Provider Information | |||||||||
| NPI: | 1952035891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONSERRAT | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | LUZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 INNOVATION WAY UNIT 8812-114 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336197313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018287060 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6182 N US HIGHWAY 41 UNIT A33572 | ||||||||
| Address2: | |||||||||
| City: | APOLLO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335721802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137710329 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2022 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 27304 | FL | Y | Dental Providers | Dentist |
No ID Information.