Provider Demographics
NPI:1205006335
Name:GRACIA, MARIMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIMAR
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 STANHOPE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3405
Mailing Address - Country:US
Mailing Address - Phone:718-708-7806
Mailing Address - Fax:
Practice Address - Street 1:143 ESSEX ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2336
Practice Address - Country:US
Practice Address - Phone:212-228-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist