Provider Demographics
NPI:1316551609
Name:MARIANNA ZADOV, P.A
Entity Type:Organization
Organization Name:MARIANNA ZADOV, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-241-7656
Mailing Address - Street 1:1027 PATHFINDER WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3267
Mailing Address - Country:US
Mailing Address - Phone:321-632-1700
Mailing Address - Fax:
Practice Address - Street 1:1027 PATHFINDER WAY STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3267
Practice Address - Country:US
Practice Address - Phone:321-632-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIANNA ZADOV, P.A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty