Provider Demographics
NPI:1699972570
Name:MARIA LOURDES DIMATERA DMD
Entity type:Organization
Organization Name:MARIA LOURDES DIMATERA DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA LOURDES
Authorized Official - Middle Name:BRIZ
Authorized Official - Last Name:DIMATERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:559-876-1777
Mailing Address - Street 1:801 N ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-3115
Mailing Address - Country:US
Mailing Address - Phone:559-876-1777
Mailing Address - Fax:559-876-2763
Practice Address - Street 1:801 N ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-3115
Practice Address - Country:US
Practice Address - Phone:559-876-1777
Practice Address - Fax:559-876-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44862OtherBILLING PROVIDER NUMBER
CAG9408101OtherDENTICAL BILLING NUMBER