Provider Demographics
NPI:1497948475
Name:JUSTINIANO, MARICARMEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARICARMEN
Middle Name:
Last Name:JUSTINIANO
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 1:28 SAINT ANTHONY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2388
Mailing Address - Country:US
Mailing Address - Phone:716-208-3222
Mailing Address - Fax:
Practice Address - Street 1:5875 S TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6340
Practice Address - Country:US
Practice Address - Phone:716-280-1001
Practice Address - Fax:716-280-1005
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053197-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice