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General NPI Number Information
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NPI Number | 1336652858
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Entity Type | Organization
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Legal Business Name | MARINO FAMILY DENTAL LLC
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 4506 N UNIVERSITY DR
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City | LAUDERHILL
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State | FL
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Zip | 33351-5740
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Country | US
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Telephone | 954-386-7500
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Fax | 954-386-7777
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Provider Business Mailing Address
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Address Line | 2401 NW 107TH AVE
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City | SUNRISE
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State | FL
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Zip | 33322-2528
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Country | US
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Telephone | 954-386-7500
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Fax | 954-386-7777
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANELISSE MARINO
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Credential | DMD
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Telephone | 813-833-9597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN20192
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License Number State | FL
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