Provider Demographics
NPI:1538509542
Name:MARA, GJERGJ (DMD)
Entity Type:Individual
Prefix:DR
First Name:GJERGJ
Middle Name:
Last Name:MARA
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 1:3466 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8406
Mailing Address - Country:US
Mailing Address - Phone:941-927-1705
Mailing Address - Fax:
Practice Address - Street 1:3466 CLARK RD
Practice Address - Street 2:SUITE 410
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8406
Practice Address - Country:US
Practice Address - Phone:941-927-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039613122300000X
FLDN21701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist