Provider Demographics
NPI:1457751075
Name:MARIN JIMENEZ, LAURA MARCELA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARCELA
Last Name:MARIN JIMENEZ
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 1:12418 NW 11TH LN # 2110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2461
Mailing Address - Country:US
Mailing Address - Phone:786-554-4670
Mailing Address - Fax:
Practice Address - Street 1:4039 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6772
Practice Address - Country:US
Practice Address - Phone:407-892-1643
Practice Address - Fax:407-892-9143
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN209431223G0001X
PADS0401711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice