Provider Demographics
NPI:1073789582
Name:OVIEDO-MARMO, MARLENE IMELDA
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:IMELDA
Last Name:OVIEDO-MARMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JACKSON RD STE C2
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9281
Mailing Address - Country:US
Mailing Address - Phone:609-654-2772
Mailing Address - Fax:
Practice Address - Street 1:30 JACKSON RD STE C2
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9281
Practice Address - Country:US
Practice Address - Phone:609-654-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI 021367001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics