Healthcare Provider Details

I. General information

NPI: 1285279323
Provider Name (Legal Business Name): MARIANAS DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TSL PLAZA 2ND FLOOR BEACH ROAD
SAIPAN MP
96950
US

IV. Provider business mailing address

PO BOX 504699
SAIPAN MP
96950-4307
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-3810
  • Fax: 670-234-3820
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NEIL LIMBO
Title or Position: PRESIDENT/ OWNER
Credential: DDS
Phone: 671-988-6345