Provider Demographics
NPI:1235283243
Name:MARINI, LUCIANO DOMENIC (DMD)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:DOMENIC
Last Name:MARINI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LAKESIDE BLVD E
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2913
Mailing Address - Country:US
Mailing Address - Phone:203-575-9097
Mailing Address - Fax:203-575-0824
Practice Address - Street 1:26 LAKESIDE BLVD E
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2913
Practice Address - Country:US
Practice Address - Phone:203-575-9097
Practice Address - Fax:203-575-0824
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist