Provider Demographics
NPI:1104190792
Name:DEMETRIUS MARKETING LLC
Entity Type:Organization
Organization Name:DEMETRIUS MARKETING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-212-2194
Mailing Address - Street 1:775 SHROPSHIRE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2570 SOUTH ATLANTIC AVE.
Practice Address - Street 2:MARINA DENTAL CENTER
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118
Practice Address - Country:US
Practice Address - Phone:386-304-2679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty