Provider Demographics
NPI:1205019973
Name:AMELINCKX, MARINA EUGENIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:EUGENIA
Last Name:AMELINCKX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 NW 82ND AVE
Mailing Address - Street 2:#305
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6658
Mailing Address - Country:US
Mailing Address - Phone:305-591-0999
Mailing Address - Fax:
Practice Address - Street 1:3650 NW 82ND AVE
Practice Address - Street 2:#305
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6658
Practice Address - Country:US
Practice Address - Phone:305-591-0999
Practice Address - Fax:305-591-0994
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 161251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics