Basic Information
Provider Information
NPI: 1669530812
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FROST
FirstName: MARIANA
MiddleName: CARINA
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1543 PRESIDENTIAL WAY
Address2:  
City: MIAMI
State: FL
PostalCode: 331796433
CountryCode: US
TelephoneNumber: 3056821573
FaxNumber:  
Practice Location
Address1: 3200 S UNIVERSITY DR
Address2:  
City: DAVIE
State: FL
PostalCode: 333282018
CountryCode: US
TelephoneNumber: 9542621919
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/04/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X436FLY Dental ProvidersDentist 

No ID Information.


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