Provider Demographics
NPI:1972917607
Name:DE LA CERDA, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DE LA CERDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 6TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5450
Mailing Address - Country:US
Mailing Address - Phone:253-777-4461
Mailing Address - Fax:253-752-0220
Practice Address - Street 1:3602 6TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5450
Practice Address - Country:US
Practice Address - Phone:253-777-4461
Practice Address - Fax:253-752-0220
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD1 60465005126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant