Provider Demographics
NPI:1609326115
Name:MARCOM, KARINE (DDS)
Entity Type:Individual
Prefix:
First Name:KARINE
Middle Name:
Last Name:MARCOM
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 1:650 N OAKLAND AVE
Mailing Address - Street 2:#107
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1160
Mailing Address - Country:US
Mailing Address - Phone:916-715-8860
Mailing Address - Fax:
Practice Address - Street 1:303 S GLENOAKS BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1319
Practice Address - Country:US
Practice Address - Phone:818-846-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist