Provider Demographics
NPI:1184510471
Name:HARGROVE, MARISSA (CRDH, OMT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:CRDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 WARBLER LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8233
Mailing Address - Country:US
Mailing Address - Phone:941-704-4779
Mailing Address - Fax:
Practice Address - Street 1:6222 WARBLER LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8233
Practice Address - Country:US
Practice Address - Phone:941-704-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26790124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist