Provider Demographics
NPI:1073877445
Name:MARINCHENKO, ANDREW (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MARINCHENKO
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 1:307 E 239TH ST
Mailing Address - Street 2:1 E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1855
Mailing Address - Country:US
Mailing Address - Phone:267-752-8760
Mailing Address - Fax:
Practice Address - Street 1:191 PRESIDENTIAL BLVD
Practice Address - Street 2:W-4
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1207
Practice Address - Country:US
Practice Address - Phone:610-664-3636
Practice Address - Fax:610-664-5060
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice