Provider Demographics
NPI:1306859574
Name:MARRA, FREDERICK J (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:MARRA
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 1:100 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047
Mailing Address - Country:US
Mailing Address - Phone:518-237-0019
Mailing Address - Fax:518-237-5461
Practice Address - Street 1:100 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047
Practice Address - Country:US
Practice Address - Phone:518-237-0019
Practice Address - Fax:518-237-5461
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist