Provider Demographics
NPI:1396925921
Name:ECHAVERRY-CENTENO, MARIA GABRIELA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GABRIELA
Last Name:ECHAVERRY-CENTENO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:N/A
Mailing Address - Street 1:PO BOX 6230
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-6230
Mailing Address - Country:US
Mailing Address - Phone:559-974-6392
Mailing Address - Fax:
Practice Address - Street 1:2841 TULARE ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1320
Practice Address - Country:US
Practice Address - Phone:559-222-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist