Provider Demographics
NPI:1568788800
Name:CONTRERAS, MARCO ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONIO
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 N KENDALL DR
Mailing Address - Street 2:SUITE #114
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8708
Mailing Address - Country:US
Mailing Address - Phone:305-595-1131
Mailing Address - Fax:305-595-1143
Practice Address - Street 1:10621 N KENDALL DR
Practice Address - Street 2:SUITE #114
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8708
Practice Address - Country:US
Practice Address - Phone:305-595-1131
Practice Address - Fax:305-595-1143
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN189541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice