Provider Demographics
NPI:1275263071
Name:TADROS, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:TADROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 SANTA BARBARA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4447
Mailing Address - Country:US
Mailing Address - Phone:239-800-3955
Mailing Address - Fax:239-800-3929
Practice Address - Street 1:2529 SANTA BARBARA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4447
Practice Address - Country:US
Practice Address - Phone:239-800-3955
Practice Address - Fax:239-800-3929
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist