Provider Demographics
NPI:1629059571
Name:MAROUNI, MICHAEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:MAROUNI
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 1:3901 MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5432
Mailing Address - Country:US
Mailing Address - Phone:718-461-5470
Mailing Address - Fax:
Practice Address - Street 1:3901 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5432
Practice Address - Country:US
Practice Address - Phone:718-461-5470
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics