Healthcare Provider Details

I. General information

NPI: 1205048857
Provider Name (Legal Business Name): MARINELA M. NEMETZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12421 SAN JOSE BLVD SUITE #320
JACKSONVILLE FL
32223-2680
US

IV. Provider business mailing address

12421 SAN JOSE BLVD SUITE #320
JACKSONVILLE FL
32223-2680
US

V. Phone/Fax

Practice location:
  • Phone: 904-292-2210
  • Fax: 904-292-2205
Mailing address:
  • Phone: 904-292-2210
  • Fax: 904-292-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN15458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: