Provider Demographics
NPI:1366462681
Name:LEYTE-VIDAL, MARCO ANTONI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONI
Last Name:LEYTE-VIDAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 SUNSET DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4827
Mailing Address - Country:US
Mailing Address - Phone:305-661-7810
Mailing Address - Fax:305-661-9353
Practice Address - Street 1:6280 SUNSET DR
Practice Address - Street 2:SUITE 404
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4827
Practice Address - Country:US
Practice Address - Phone:305-661-7810
Practice Address - Fax:305-661-9353
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice