# MARIANNA ZADOV, P.A

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Polo Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841579257
- **Authorized official:** SIMON LEIZGOLD (VP)
- **Authorized official phone:** (561) 241-7656

## Contact information

- **Practice address:** 5030 CHAMPION BLVD STE G4, BOCA RATON, FL 33496-2478
- **Practice address phone:** (561) 241-7656
- **Mailing address:** 1905 CLINT MOORE RD STE 200, BOCA RATON, FL 33496-2660
- **Mailing address phone:** (561) 241-7656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN164481 | FL | Yes |

## Other

- **Enumeration date:** 08/16/2011
- **Last updated:** 09/03/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1104903301 | — | FL |