Provider Demographics
NPI:1043438278
Name:MARCIANO, NICHOLAS JOSEPH (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:MARCIANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 BONITA BEACH RD.
Mailing Address - Street 2:117
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4162
Mailing Address - Country:US
Mailing Address - Phone:239-591-2961
Mailing Address - Fax:
Practice Address - Street 1:3300 BONITA BEACH RD
Practice Address - Street 2:117
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4162
Practice Address - Country:US
Practice Address - Phone:239-947-6610
Practice Address - Fax:239-947-3247
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist