Provider Demographics
NPI:1093724775
Name:MARCINCIN, MARYBETH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARYBETH
Middle Name:
Last Name:MARCINCIN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 MILLARD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2632
Mailing Address - Country:US
Mailing Address - Phone:610-691-1461
Mailing Address - Fax:610-691-4184
Practice Address - Street 1:1414 MILLARD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2632
Practice Address - Country:US
Practice Address - Phone:610-691-1461
Practice Address - Fax:610-691-4184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026773L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2710202OtherFEDERAL TAX ID
PADS026773LOtherDENTAL LICENSE NUMBER