Provider Demographics
NPI:1962061549
Name:ALONSO CABRERA, MARLYS (DMD)
Entity type:Individual
Prefix:
First Name:MARLYS
Middle Name:
Last Name:ALONSO CABRERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3321
Mailing Address - Country:US
Mailing Address - Phone:904-323-0995
Mailing Address - Fax:
Practice Address - Street 1:2800 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3321
Practice Address - Country:US
Practice Address - Phone:832-296-1746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2022-09-16
Deactivation Date:2019-06-07
Deactivation Code:
Reactivation Date:2022-09-16
Provider Licenses
StateLicense IDTaxonomies
FL24238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist