Provider Demographics
NPI:1710013297
Name:ALBERTS, MARCO A (DMD, MPH)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:ALBERTS
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 49TH ST N
Mailing Address - Street 2:ATTN: NORTH DIVISION MEDICAL
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-2877
Mailing Address - Country:US
Mailing Address - Phone:727-464-6415
Mailing Address - Fax:
Practice Address - Street 1:14400 49TH ST N
Practice Address - Street 2:ATTN: NORTH DIVISION MEDICAL
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-2877
Practice Address - Country:US
Practice Address - Phone:727-464-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000099571223G0001X
FLDN 97641223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5037171Medicaid
FL0004418100Medicaid