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Organization
MARIANNA ZADOV, P.A
Active
Organization
MARIANNA ZADOV, P.A
Active
Other names
Polo Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SIMON LEIZGOLD (VP)
(561) 241-7656
Entity
Organization
Contact information
Practice address
5030 CHAMPION BLVD STE G4, BOCA RATON, FL 33496-2478
(561) 241-7656
Mailing address
1905 CLINT MOORE RD STE 200, BOCA RATON, FL 33496-2660
(561) 241-7656
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN164481
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104903301
—
FL
Enumeration date
08/16/2011
Last updated
09/03/2020
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