Healthcare Provider Details

I. General information

NPI: 1629763206
Provider Name (Legal Business Name): MARIE DEL AGUILA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 SONOMA AVE STE 108
SANTA ROSA CA
95405-4812
US

IV. Provider business mailing address

1793 6TH AVE
REDLANDS CA
92374-6475
US

V. Phone/Fax

Practice location:
  • Phone: 707-523-2399
  • Fax:
Mailing address:
  • Phone: 909-557-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS110558
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: