Provider Demographics
NPI:1518143775
Name:MARCOS-ARENAL, JOSE LUIS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSE LUIS
Middle Name:
Last Name:MARCOS-ARENAL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1562 WELLS RD STE 16
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-1723
Practice Address - Country:US
Practice Address - Phone:904-644-0140
Practice Address - Fax:904-644-0143
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 181831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics