Provider Demographics
NPI:1023302460
Name:CARDENAS D'HERS, MARIANELA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARIANELA
Middle Name:
Last Name:CARDENAS D'HERS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MARIANELA
Other - Middle Name:
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:3177 NW 103RD PATH
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5053
Mailing Address - Country:US
Mailing Address - Phone:786-312-1770
Mailing Address - Fax:
Practice Address - Street 1:20335 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1800
Practice Address - Country:US
Practice Address - Phone:305-238-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19306122300000X
FLDN193061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist