Provider Demographics
NPI:1750361473
Name:MARINI, RONALD MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MICHAEL
Last Name:MARINI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:772 SENECA MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4722
Mailing Address - Country:US
Mailing Address - Phone:407-925-3306
Mailing Address - Fax:407-322-4415
Practice Address - Street 1:2921 S ORLANDO DR
Practice Address - Street 2:SUITE 146
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4103
Practice Address - Country:US
Practice Address - Phone:407-322-9992
Practice Address - Fax:407-322-4415
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN84411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL074986900Medicaid
FL991268OtherCOMPDENT HEALTHY KIDS
FL076031500Medicaid