Provider Demographics
NPI:1902814791
Name:CALIMAREA, LYDIA MARIN (DMD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIN
Last Name:CALIMAREA
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 1:1525 HERBERT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PROT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129
Mailing Address - Country:US
Mailing Address - Phone:386-322-7786
Mailing Address - Fax:386-761-3920
Practice Address - Street 1:1525 HERBERT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PROT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129
Practice Address - Country:US
Practice Address - Phone:386-322-7786
Practice Address - Fax:386-761-3920
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist