Provider Demographics
NPI:1962514042
Name:LAUZAN-MADRUGA, MARIA EMILIA (DMD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:EMILIA
Last Name:LAUZAN-MADRUGA
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 1:4401 E COLONIAL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5200
Mailing Address - Country:US
Mailing Address - Phone:407-228-2251
Mailing Address - Fax:
Practice Address - Street 1:4401 E COLONIAL DR STE 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5200
Practice Address - Country:US
Practice Address - Phone:407-228-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17177122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist