Provider Demographics
NPI:1457005571
Name:NELSON ROBERTO MARQUES DDS PA
Entity Type:Organization
Organization Name:NELSON ROBERTO MARQUES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-451-8942
Mailing Address - Street 1:28029 HWY 27
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4276
Mailing Address - Country:US
Mailing Address - Phone:863-258-1093
Mailing Address - Fax:
Practice Address - Street 1:28029 HWY 27
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4276
Practice Address - Country:US
Practice Address - Phone:863-258-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty