Provider Demographics
NPI:1033842521
Name:MARIELLA, MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:MARIELLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 TOLLGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANCASTER
Mailing Address - State:ON
Mailing Address - Zip Code:L9G 5C8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:176 TOLLGATE DRIVE
Practice Address - Street 2:
Practice Address - City:ANCASTER
Practice Address - State:ON
Practice Address - Zip Code:L9G 5C8
Practice Address - Country:CA
Practice Address - Phone:905-304-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program