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General NPI Number Information
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NPI Number | 1023264488
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Entity Type | Individual
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Provider Name | MARVIN JAY LADOV D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 7305 N MILITARY TRL
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City | RIVIERA BEACH
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State | FL
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Zip | 33410-7417
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Country | US
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Telephone | 561-422-6576
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Fax |
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Provider Business Mailing Address
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Address Line | 7124 TRADITION COVE LN W
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-3018
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Country | US
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Telephone | 561-799-6239
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Fax | 561-799-9223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DI07365
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License Number State | NJ
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