Provider Demographics
NPI:1386656171
Name:MARINO, TODD ANTHONY (DDS,PLC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANTHONY
Last Name:MARINO
Suffix:
Gender:M
Credentials:DDS,PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-8301
Mailing Address - Country:US
Mailing Address - Phone:989-793-9100
Mailing Address - Fax:989-793-9102
Practice Address - Street 1:6415 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-8301
Practice Address - Country:US
Practice Address - Phone:989-793-9100
Practice Address - Fax:989-793-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist