Healthcare Provider Details

I. General information

NPI: 1912608043
Provider Name (Legal Business Name): MARIOLI LUCIANO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3394
US

IV. Provider business mailing address

361 CALLE GALILEO APT 2K
SAN JUAN PR
00927-4511
US

V. Phone/Fax

Practice location:
  • Phone: 904-256-7846
  • Fax:
Mailing address:
  • Phone: 787-232-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: