Provider Demographics
NPI:1114908019
Name:MARINO, CARLO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:
Last Name:MARINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 GRAHAM RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1204
Mailing Address - Country:US
Mailing Address - Phone:330-920-8060
Mailing Address - Fax:330-920-9779
Practice Address - Street 1:63 GRAHAM RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1204
Practice Address - Country:US
Practice Address - Phone:330-920-8060
Practice Address - Fax:330-920-9779
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0842271Medicaid