Provider Demographics
NPI:1366507022
Name:MARINO, BRIAN MATTHEW (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MATTHEW
Last Name:MARINO
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 1:567 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1737
Mailing Address - Country:US
Mailing Address - Phone:973-831-0444
Mailing Address - Fax:973-831-7770
Practice Address - Street 1:567 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1737
Practice Address - Country:US
Practice Address - Phone:973-831-0444
Practice Address - Fax:973-831-7770
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022089001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice