Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DI07365 | NJ |
NPI | 1023264488 |
---|---|
Provider Name | Dr. Marvin Jay Ladov |
First Address | West Palm Beach, FL 33412-3018 |
Second Address | Riviera Beach, FL 33410-7417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2008 |
Last Update Date | 15/08/2008 |