Healthcare Provider Details

I. General information

NPI: 1962563205
Provider Name (Legal Business Name): MARILYN PALACIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 NE 36TH AVE
OCALA FL
34470-4930
US

IV. Provider business mailing address

1220 NE 36TH AVE
OCALA FL
34470-4930
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-4847
  • Fax:
Mailing address:
  • Phone: 352-732-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN15314
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN 15314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: