Provider Demographics
NPI:1285773465
Name:RONALD M MARINI DMD PA
Entity type:Organization
Organization Name:RONALD M MARINI DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-322-9992
Mailing Address - Street 1:1495 STELLAR DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9685
Mailing Address - Country:US
Mailing Address - Phone:407-365-3817
Mailing Address - Fax:
Practice Address - Street 1:2921 S ORLANDO DR
Practice Address - Street 2:SUITE 146
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4103
Practice Address - Country:US
Practice Address - Phone:407-322-9992
Practice Address - Fax:407-322-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN84411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL991268OtherCOMDENT HEALTHY KIDS
FL076031500Medicaid
FL074986900Medicaid