MEDICARE: MARIA M. EGUSQUIZA DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN0012314	FL

General Provider Information

NPI Number	:	1659828705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA M. EGUSQUIZA DMD PA

Provider Business Mailing Address
First Line	:	3676 COLLIN DR
Second Line	:	SUITE 4
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-4727
Country	:	US
Telephone Number	:	561-965-0292
Fax Number	:	561-965-0256

Provider Business Practice Location Address
First Line	:	3676 COLLIN DR
Second Line	:	SUITE 4
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-4727
Country	:	US
Telephone Number	:	561-965-0292
Fax Number	:	561-965-0256

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	MARIA M EGUSQUIZA
Credential	:	DMD
Telephone Number	:	561-965-0292

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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