Provider Demographics
NPI:1215166855
Name:PANOPIO, MARIVIC BAUTISTA (RDH)
Entity type:Individual
Prefix:MISS
First Name:MARIVIC
Middle Name:BAUTISTA
Last Name:PANOPIO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-3231
Mailing Address - Country:US
Mailing Address - Phone:305-685-7863
Mailing Address - Fax:305-687-7603
Practice Address - Street 1:1245 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-3231
Practice Address - Country:US
Practice Address - Phone:305-685-7863
Practice Address - Fax:305-687-7603
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH18958124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist