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General NPI Number Information
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NPI Number | 1437424710
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Entity Type | Organization
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Legal Business Name | MARCIANO DENTAL GROUP
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 26711 DUBLIN WOODS CIR
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-7245
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Country | US
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Telephone | 239-947-6610
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Fax | 239-405-8642
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Provider Business Mailing Address
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Address Line | 26711 DUBLIN WOODS CIR
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-7245
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Country | US
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Telephone | 239-947-6610
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Fax | 239-405-8642
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS J MARCIANO
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Credential |
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Telephone | 239-947-6610
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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 | DN16569
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License Number State | FL
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