Provider Demographics
NPI:1992073456
Name:DESOUZA, MARIANNE BEAULIEU (RDH)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:BEAULIEU
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 IVERS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4402
Mailing Address - Country:US
Mailing Address - Phone:774-628-9878
Mailing Address - Fax:774-628-9878
Practice Address - Street 1:1213 PURCHASE ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6694
Practice Address - Country:US
Practice Address - Phone:508-991-6288
Practice Address - Fax:508-991-6291
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist