Individual
MARCIO A DAFONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
555 S. 18TH STREET, COLUMBUS, OH 43205
(614) 722-4579
(614) 722-4565
Mailing address
555 S. 18TH STREET, COLUMBUS, OH 43205
(614) 722-4579
(614) 722-4565
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
71000193
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0243972
—
OH
Enumeration date
10/02/2006
Last updated
07/09/2007
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