Provider Demographics
NPI:1952312415
Name:MARCUS, GINA (DMD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MARCUS
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 1:2600 S DOUGLAS RD STE 906
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6142
Mailing Address - Country:US
Mailing Address - Phone:305-998-2970
Mailing Address - Fax:305-374-5551
Practice Address - Street 1:2600 S DOUGLAS RD STE 906
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6142
Practice Address - Country:US
Practice Address - Phone:305-998-2970
Practice Address - Fax:305-374-5551
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 163881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1598841496OtherDENTAL