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General NPI Number Information
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NPI Number | 1053202093
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Entity Type | Individual
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Provider Name | MARIJAN DE VANNA
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Gender | Female
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1096 W 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3322
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Country | US
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Telephone | 305-370-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 7626 NE 6TH CT APT 2
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City | MIAMI
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State | FL
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Zip | 33138-5145
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Country | US
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Telephone | 305-399-0028
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30732
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License Number State | FL
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