Provider Demographics
NPI:1316184500
Name:MARISENOJ, BESA (DMD)
Entity Type:Individual
Prefix:DR
First Name:BESA
Middle Name:
Last Name:MARISENOJ
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 1:621 KATAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3422
Mailing Address - Country:US
Mailing Address - Phone:718-948-4000
Mailing Address - Fax:
Practice Address - Street 1:621 KATAN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3422
Practice Address - Country:US
Practice Address - Phone:718-948-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0540541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice