Provider Demographics
NPI:1609070358
Name:MARMARA, VERONICA (DDS)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MARMARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5953 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3903
Mailing Address - Country:US
Mailing Address - Phone:718-381-1963
Mailing Address - Fax:
Practice Address - Street 1:8710 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4444
Practice Address - Country:US
Practice Address - Phone:718-429-8300
Practice Address - Fax:516-822-2396
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047468-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01922729Medicaid