Provider Demographics
NPI:1417042060
Name:QUIROZ, MARILOU DIZON (DMD)
Entity type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:DIZON
Last Name:QUIROZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 EAST PALOMAR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913
Mailing Address - Country:US
Mailing Address - Phone:619-941-1820
Mailing Address - Fax:619-941-1821
Practice Address - Street 1:1392 EAST PALOMAR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913
Practice Address - Country:US
Practice Address - Phone:619-941-1820
Practice Address - Fax:619-941-1821
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice