Provider Demographics
NPI:1073072245
Name:MASTROMARINO, SILVIANO JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:SILVIANO
Middle Name:JOSEPH
Last Name:MASTROMARINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6591
Mailing Address - Country:US
Mailing Address - Phone:919-999-8978
Mailing Address - Fax:
Practice Address - Street 1:2064 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-9436
Practice Address - Country:US
Practice Address - Phone:252-536-5880
Practice Address - Fax:252-536-2708
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice