Provider Demographics
NPI:1578696100
Name:LUNG, MARIELA K (DMD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:K
Last Name:LUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 S LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2558
Mailing Address - Country:US
Mailing Address - Phone:863-647-3222
Mailing Address - Fax:863-644-0577
Practice Address - Street 1:5055 S LAKELAND DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2558
Practice Address - Country:US
Practice Address - Phone:863-647-3222
Practice Address - Fax:863-644-0577
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice