Provider Demographics
NPI:1720755457
Name:MARIANNA ZADOV, P.A
Entity Type:Organization
Organization Name:MARIANNA ZADOV, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-241-7656
Mailing Address - Street 1:1905 CLINT MOORE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2660
Mailing Address - Country:US
Mailing Address - Phone:561-241-7656
Mailing Address - Fax:
Practice Address - Street 1:7350 SANDLAKE COMMONS BLVD STE 3305
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8031
Practice Address - Country:US
Practice Address - Phone:407-216-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIANNA ZADOV, P.A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty