Provider Demographics
NPI:1093738338
Name:MARRO-TOBIN, MARYJO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYJO
Middle Name:
Last Name:MARRO-TOBIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARYJO
Other - Middle Name:
Other - Last Name:TOBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6200 SLOCUM RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9142
Mailing Address - Country:US
Mailing Address - Phone:315-524-7433
Mailing Address - Fax:
Practice Address - Street 1:6200 SLOCUM RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9142
Practice Address - Country:US
Practice Address - Phone:315-524-7433
Practice Address - Fax:315-524-2920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist