Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN8921 | FL |
NPI | 1053556696 |
---|---|
Provider Name | Dr. Richard C. Mariani JR. |
First Address | South Miami, FL 33143-4908 |
Second Address | South Miami, FL 33143-4908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 11/12/2008 |