Healthcare Provider Details

I. General information

NPI: 1043663479
Provider Name (Legal Business Name): MAITHILI BAPAT MARATHE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 E PACIFIC COAST HWY UNIT A-6
LONG BEACH CA
90803-4201
US

IV. Provider business mailing address

28 COUNTRY RIDGE RD
POMONA CA
91766-4815
US

V. Phone/Fax

Practice location:
  • Phone: 562-735-3623
  • Fax:
Mailing address:
  • Phone: 909-374-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: