1285773465 NPI number — RONALD M MARINI DMD PA

Table of content: (NPI 1285773465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285773465 NPI number — RONALD M MARINI DMD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD M MARINI DMD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285773465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1495 STELLAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-9685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-365-3817
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2921 S ORLANDO DR
Provider Second Line Business Practice Location Address:
SUITE 146
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32773-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-322-9992
Provider Business Practice Location Address Fax Number:
407-322-4415
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARINI
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-322-9992

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN8441 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 991268 . This is a "COMDENT HEALTHY KIDS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 076031500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 074986900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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