Provider Demographics
NPI:1962072462
Name:ARIETA FROTA DE SOUZA, LUIZA (DMD)
Entity type:Individual
Prefix:
First Name:LUIZA
Middle Name:
Last Name:ARIETA FROTA DE SOUZA
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 1:108 VIP DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7975
Mailing Address - Country:US
Mailing Address - Phone:724-935-0700
Mailing Address - Fax:724-935-2834
Practice Address - Street 1:108 VIP DR STE 105
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7975
Practice Address - Country:US
Practice Address - Phone:724-935-0700
Practice Address - Fax:724-935-2834
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0431841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice