Provider Demographics
NPI:1114005519
Name:MENZANO, LINDA L
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:MENZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9705 NW 67TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3311
Mailing Address - Country:US
Mailing Address - Phone:754-264-9542
Mailing Address - Fax:
Practice Address - Street 1:35 STONYBROOK DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2216
Practice Address - Country:US
Practice Address - Phone:215-946-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant