Healthcare Provider Details

I. General information

NPI: 1831855253
Provider Name (Legal Business Name): MARC EDOUARD LARRIEUX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 AIPORT PULLING RD
NAPLES FL
34109-3410
US

IV. Provider business mailing address

1355 MARIPOSA CIR APT 201
NAPLES FL
34105-7260
US

V. Phone/Fax

Practice location:
  • Phone: 239-597-7032
  • Fax:
Mailing address:
  • Phone: 239-200-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH21633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: