Provider Demographics
NPI:1669033635
Name:MARCELINO J MARENCO DDS PA
Entity Type:Organization
Organization Name:MARCELINO J MARENCO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELINO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARENCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-228-0800
Mailing Address - Street 1:13155 SW 42ND ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3428
Mailing Address - Country:US
Mailing Address - Phone:305-208-0800
Mailing Address - Fax:
Practice Address - Street 1:13155 SW 42ND ST STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3428
Practice Address - Country:US
Practice Address - Phone:305-208-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083772198OtherSINGLE NPI