Healthcare Provider Details

I. General information

NPI: 1902499692
Provider Name (Legal Business Name): MRS. MARIA C CHARRON I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NW 76TH BLVD
GAINESVILLE FL
32606-6747
US

IV. Provider business mailing address

1010 NW 76TH BLVD
GAINESVILLE FL
32606-6747
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-4180
  • Fax:
Mailing address:
  • Phone: 352-332-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH21656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: