Active NPI
Marijan De Vanna
- Dentist
- Hialeah, FL
National Provider Identifier
1053202093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30732
- Practice address
- 1096 W 49TH St
Hialeah, FL 33012-3322 - Phone
- (305) 370-4000
- NPI assigned
- Jul 9, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30732 | FL | Primary |
Addresses
Primary practice location
1096 W 49TH St
Hialeah, FL 33012-3322
Mailing address
7626 NE 6TH CT Apt 2
Miami, FL 33138-5145
Phone (305) 399-0028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30732 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752019200000",
"number": "1053202093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7626 NE 6TH CT APT 2",
"city": "MIAMI",
"state": "FL",
"postal_code": "331385145",
"telephone_number": "305-399-0028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1096 W 49TH ST",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330123322",
"telephone_number": "305-370-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE VANNA",
"first_name": "MARIJAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-09",
"last_updated": "2025-07-09",
"certification_date": "2025-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "30732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.