Basic Information
| Provider Information | |||||||||
| NPI: | 1316043474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSH-FILIPCZAK | ||||||||
| FirstName: | DONNIE | ||||||||
| MiddleName: | LEITH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4440 FRUITVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342321926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413004440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8390 N PALAFOX ST | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325343735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509885245 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN14619 | FL | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | DN0014619 | 01 | FL | STATE LICENSE NUMBER | OTHER |