Provider Demographics
NPI:1831212182
Name:LYDIA MARIN CALIMAREA DMD,PA
Entity type:Organization
Organization Name:LYDIA MARIN CALIMAREA DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:MARIN
Authorized Official - Last Name:CALIMAREA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-756-9298
Mailing Address - Street 1:1047 POCATELLO COURT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129
Mailing Address - Country:US
Mailing Address - Phone:386-756-9298
Mailing Address - Fax:386-322-7421
Practice Address - Street 1:1525 HERBERT STREET,SUIT 101
Practice Address - Street 2:
Practice Address - City:PORET ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129
Practice Address - Country:US
Practice Address - Phone:386-322-7786
Practice Address - Fax:386-761-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 11781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty