Provider Demographics
NPI:1679196679
Name:PETER D MARO JR D M D M S P C
Entity Type:Organization
Organization Name:PETER D MARO JR D M D M S P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MARO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-967-2277
Mailing Address - Street 1:6 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5608
Mailing Address - Country:US
Mailing Address - Phone:203-829-4614
Mailing Address - Fax:
Practice Address - Street 1:262 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2169
Practice Address - Country:US
Practice Address - Phone:914-967-2277
Practice Address - Fax:914-967-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty