Provider Demographics
NPI:1346336344
Name:MARINO, VINCENT JOHN (DDS)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JOHN
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 1:727 N 77 SUNSHINE STRIP
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8847
Mailing Address - Country:US
Mailing Address - Phone:956-428-3691
Mailing Address - Fax:956-428-3057
Practice Address - Street 1:727 N 77 SUNSHINE STRIP
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8847
Practice Address - Country:US
Practice Address - Phone:956-428-5691
Practice Address - Fax:956-428-3057
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B12304-1OtherDELTA CHIP
797154OtherUNITED CONCORDIA