Healthcare Provider Details

I. General information

NPI: 1063330553
Provider Name (Legal Business Name): MARION DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13690 N US HIGHWAY 441 STE 100
LADY LAKE FL
32159-6809
US

IV. Provider business mailing address

13690 N US HIGHWAY 441 STE 100
LADY LAKE FL
32159-6809
US

V. Phone/Fax

Practice location:
  • Phone: 352-259-0822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: PETE BILAN
Title or Position: CFO
Credential:
Phone: 941-232-8433