Provider Demographics
NPI:1346445756
Name:MARCOVICH, CLARISSA KATIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:KATIA
Last Name:MARCOVICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:219 TOM HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5301
Mailing Address - Country:US
Mailing Address - Phone:201-482-4017
Mailing Address - Fax:201-461-1524
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:SUITE 804
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-753-2676
Practice Address - Fax:212-753-2676
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0446551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry