Provider Demographics
NPI:1518380849
Name:MARIN, CARLOS (RDA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:MARIN
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10602 CHAPMAN AVE
Mailing Address - Street 2:SUITE
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3146
Mailing Address - Country:US
Mailing Address - Phone:714-638-5990
Mailing Address - Fax:714-638-5992
Practice Address - Street 1:10602 CHAPMAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3146
Practice Address - Country:US
Practice Address - Phone:714-638-5990
Practice Address - Fax:714-638-5992
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66429126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant