Provider Demographics
NPI:1982970158
Name:MARIANI SHAH LEGACY FAMILY DENTAL
Entity Type:Organization
Organization Name:MARIANI SHAH LEGACY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:MARIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-336-7643
Mailing Address - Street 1:6655 POST RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8214
Mailing Address - Country:US
Mailing Address - Phone:614-336-7643
Mailing Address - Fax:614-336-7653
Practice Address - Street 1:6655 POST RD
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8214
Practice Address - Country:US
Practice Address - Phone:614-336-7643
Practice Address - Fax:614-336-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20142122300000X
OH21803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty