Provider Demographics
NPI:1609937812
Name:VIGNA, MARINO F (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:MARINO
Middle Name:F
Last Name:VIGNA
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6800
Mailing Address - Country:US
Mailing Address - Phone:954-584-9500
Mailing Address - Fax:954-584-0794
Practice Address - Street 1:5975 W SUNRISE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6800
Practice Address - Country:US
Practice Address - Phone:954-584-9500
Practice Address - Fax:954-584-0794
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00132391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice