Most Relevant Information
Provider Data
| NPI Number: | 1003436965 |
| Provider Name: | MARINA ANN MIKAEL |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 107059 |
Most Important Dates
| Enumeration Date: | 04/21/2020 |
| Last Updated: | 12/01/2021 |
Provider Practice Location
590 SOUTH AVE
WESTON
MA
024932608
Practice Location Phone/Fax
| Phone: | 7813306236 |
| Fax: |
Provider Mailing Location
590 SOUTH AVE
WESTON
MA
024932608
Provider Mailing Phone/Fax
| Phone: | 7813306236 |
| Fax: |