Provider Demographics
NPI:1093872731
Name:ANTHONY J. MARINO, D.D.S. , P.C.
Entity Type:Organization
Organization Name:ANTHONY J. MARINO, D.D.S. , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-645-7247
Mailing Address - Street 1:7004 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1950
Mailing Address - Country:US
Mailing Address - Phone:314-645-7247
Mailing Address - Fax:314-645-5649
Practice Address - Street 1:7004 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1950
Practice Address - Country:US
Practice Address - Phone:314-645-7247
Practice Address - Fax:314-645-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477597888OtherINDIVIDUAL NPI NUMBER