Provider Demographics
NPI:1447494315
Name:MARRECAU ORTHODONTICS LLC
Entity type:Organization
Organization Name:MARRECAU ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARRECAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-752-3509
Mailing Address - Street 1:5850 CORAL RIDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3379
Mailing Address - Country:US
Mailing Address - Phone:954-752-3509
Mailing Address - Fax:
Practice Address - Street 1:5850 CORAL RIDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076
Practice Address - Country:US
Practice Address - Phone:954-752-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223X0400X
FLDN182301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty