Basic Information
| Provider Information | |||||||||
| NPI: | 1518201417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUBREY | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 874 HYACINTH CT | ||||||||
| Address2: | |||||||||
| City: | MARCO ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341456814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392490395 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7007 LELY CULTURAL PKWY BLDG L | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341138976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397753052 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DTP576 | FL | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.