Provider Demographics
NPI:1326861592
Name:UPESLEJA, MARIA SOPHIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SOPHIA
Last Name:UPESLEJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37701 COLORADO AVE STE E
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2841
Mailing Address - Country:US
Mailing Address - Phone:440-934-2600
Mailing Address - Fax:440-934-2602
Practice Address - Street 1:37701 COLORADO AVE STE E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2841
Practice Address - Country:US
Practice Address - Phone:440-934-2600
Practice Address - Fax:440-934-2602
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH51.013010126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant