=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962624783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA LUCIA PINZON DDS MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2084 S MAIN STREET
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-975-8730
-----------------------------------------------------
Fax | 734-975-8733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2985 HICKORY LANE
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-369-2870
-----------------------------------------------------
Fax | 734-369-2871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 17522
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------