Individual provider · Type 1 NPI

Mario Bradford Antonioni, DDS

Student in an Organized Health Care Education/Training Program · Venice, CA

NPI number 1255894762 Active

Practice location

323 Lincoln Blvd
Venice, CA 90291-2842

Call (310) 392-4103 Map

Mailing address

5514 Stadium Dr
Madison, WI 53705-4642

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1255894762

Mario Bradford Antonioni, DDS's National Provider Identifier is 1255894762, issued on Apr 11, 2019. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Venice, CA. The record was last updated on Apr 11, 2019.