Provider Demographics
NPI:1912184631
Name:MARRERO, LOIS H (DDS)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:H
Last Name:MARRERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SW 57TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5775
Mailing Address - Country:US
Mailing Address - Phone:305-266-5859
Mailing Address - Fax:305-269-4898
Practice Address - Street 1:1350 SW 57TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-266-5859
Practice Address - Fax:305-269-4898
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 157001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice