Provider Demographics
NPI:1104164243
Name:FIASTRO, EVA T (DDS)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:T
Last Name:FIASTRO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SCOTT ADAM RD STE 308
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3360
Mailing Address - Country:US
Mailing Address - Phone:410-666-8668
Mailing Address - Fax:
Practice Address - Street 1:54 SCOTT ADAM RD STE 308
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3360
Practice Address - Country:US
Practice Address - Phone:410-666-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice