Provider Demographics
NPI:1962789891
Name:DESOUZA, MARIE-FRANCE INDIRA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE-FRANCE
Middle Name:INDIRA
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9380 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:#108
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2806
Mailing Address - Country:US
Mailing Address - Phone:410-465-3030
Mailing Address - Fax:
Practice Address - Street 1:9380 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:#108
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2806
Practice Address - Country:US
Practice Address - Phone:410-465-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD99251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice