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General NPI Number Information
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NPI Number | 1104190792
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Entity Type | Organization
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Legal Business Name | DEMETRIUS MARKETING LLC
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 2570 SOUTH ATLANTIC AVE. MARINA DENTAL CENTER
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118
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Country | US
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Telephone | 386-304-2679
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Fax |
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Provider Business Mailing Address
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Address Line | 775 SHROPSHIRE LOOP
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City | SANFORD
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State | FL
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Zip | 32771
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | CYNTHIA J POPA
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Credential | DDS
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Telephone | 407-212-2194
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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 | DN13779
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License Number State | FL
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