Provider Demographics
NPI:1275371890
Name:RABIDEAU, MARC ANTHONY (DMD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ANTHONY
Last Name:RABIDEAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TOSCANA DR APT 216
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3492
Mailing Address - Country:US
Mailing Address - Phone:616-460-3830
Mailing Address - Fax:
Practice Address - Street 1:9330 6 MILE CYPRESS PKWY # 6
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-6505
Practice Address - Country:US
Practice Address - Phone:239-337-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist