Provider Demographics
NPI:1427508605
Name:CRAMER, NINA MARIE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:MARIE
Last Name:CRAMER
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:MARIE
Other - Last Name:GUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3901 INDIGO RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-9018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12161 COUNTY ROAD 103 STE 101
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-2986
Practice Address - Country:US
Practice Address - Phone:352-419-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21204122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist