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General NPI Number Information
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NPI Number | 1831212182
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Entity Type | Organization
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Legal Business Name | LYDIA MARIN CALIMAREA DMD,PA
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1525 HERBERT STREET,SUIT 101
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City | PORET ORANGE
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State | FL
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Zip | 32129
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Country | US
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Telephone | 386-322-7786
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Fax | 386-761-3920
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Provider Business Mailing Address
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Address Line | 1047 POCATELLO COURT
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City | PORT ORANGE
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State | FL
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Zip | 32129
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Country | US
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Telephone | 386-756-9298
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Fax | 386-322-7421
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LYDIA MARIN CALIMAREA
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Credential | DMD
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Telephone | 386-756-9298
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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 | DN 11781
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License Number State | FL
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