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General NPI Number Information
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NPI Number | 1881218998
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Entity Type | Individual
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Provider Name | MARCEL FUNDORA DMD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 28550 US 19TH HWY N
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City | CLEARWATER
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State | FL
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Zip | 33761
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Country | US
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Telephone | 727-300-1594
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Fax | 727-953-3502
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Provider Business Mailing Address
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Address Line | 1706 MARINER WAY
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-5853
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Country | US
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Telephone | 787-247-6079
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN24900
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License Number State | FL
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