Provider Demographics
NPI:1548930837
Name:IRIMIA, MARCO ELADIO (DMD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ELADIO
Last Name:IRIMIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 SW 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2222
Mailing Address - Country:US
Mailing Address - Phone:305-458-1444
Mailing Address - Fax:
Practice Address - Street 1:13123 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7401
Practice Address - Country:US
Practice Address - Phone:813-397-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN258721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice