Provider Demographics
NPI:1831855253
Name:LARRIEUX, MARC EDOUARD
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:EDOUARD
Last Name:LARRIEUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 MARIPOSA CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-7260
Mailing Address - Country:US
Mailing Address - Phone:239-200-1868
Mailing Address - Fax:
Practice Address - Street 1:5445 AIPORT PULLING RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3410
Practice Address - Country:US
Practice Address - Phone:239-597-7032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH21633124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist