Provider Demographics
NPI:1104397090
Name:MARIANNA ZADOV, P.A
Entity type:Organization
Organization Name:MARIANNA ZADOV, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZADOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-305-2958
Mailing Address - Street 1:1905 CLINT MOORE RD APT 1703
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 MILITARY TRL STE 210
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7040
Practice Address - Country:US
Practice Address - Phone:561-241-7656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIANNA ZADOV, P.A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-17
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty