Provider Demographics
NPI:1912942756
Name:NEMECEK, MARCIA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:M
Last Name:NEMECEK
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 1:13 ST. JOHNS MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-471-9910
Mailing Address - Fax:904-797-2813
Practice Address - Street 1:13 SAINT JOHNS MEDICAL PK DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5304
Practice Address - Country:US
Practice Address - Phone:904-471-9910
Practice Address - Fax:904-797-2813
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00120281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0012028OtherLICENCES NO