Provider Demographics
NPI:1609958040
Name:MARCANO, JOSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:MARCANO
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 1:4861 S ORANGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6949
Mailing Address - Country:US
Mailing Address - Phone:407-855-1471
Mailing Address - Fax:407-859-9438
Practice Address - Street 1:4861 S ORANGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6949
Practice Address - Country:US
Practice Address - Phone:407-855-1471
Practice Address - Fax:407-859-9438
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-00127451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice