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General NPI Number Information
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NPI Number | 1992478036
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Entity Type | Individual
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Provider Name | MARISA REAGAN CHANIN DMD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 3301 COLLEGE AVE
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City | DAVIE
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State | FL
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Zip | 33314-7721
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Country | US
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Telephone | 407-509-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 SW 70TH TER
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City | DAVIE
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State | FL
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Zip | 33314-3126
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Country | US
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Telephone | 407-509-0187
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 26117
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License Number State | FL
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