Provider Demographics
NPI:1053556696
Name:MARIANI, RICHARD C JR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:MARIANI
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7741 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4908
Mailing Address - Country:US
Mailing Address - Phone:305-665-2402
Mailing Address - Fax:305-665-5606
Practice Address - Street 1:7741 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4908
Practice Address - Country:US
Practice Address - Phone:305-665-2402
Practice Address - Fax:305-665-5606
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN89211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics