Provider Demographics
NPI:1578751640
Name:GUZMAN, MARINO EPIFANIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINO
Middle Name:EPIFANIO
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 AUDUBON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4213
Mailing Address - Country:US
Mailing Address - Phone:212-795-3486
Mailing Address - Fax:212-543-3230
Practice Address - Street 1:311 AUDUBON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4213
Practice Address - Country:US
Practice Address - Phone:212-795-3486
Practice Address - Fax:212-543-3230
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice