Provider Demographics
NPI:1821219544
Name:JOSEPH B. MARINO, JR. D.D.S., P.C.
Entity Type:Organization
Organization Name:JOSEPH B. MARINO, JR. D.D.S., P.C.
Other - Org Name:LAKEFRONT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-282-5557
Mailing Address - Street 1:7037 CANAL BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3453
Mailing Address - Country:US
Mailing Address - Phone:504-282-5557
Mailing Address - Fax:504-286-0038
Practice Address - Street 1:7037 CANAL BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3453
Practice Address - Country:US
Practice Address - Phone:504-282-5557
Practice Address - Fax:504-286-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA116446OtherCIGNA HMO
LA4386829440OtherBCBS OF LA
LA578120OtherUCCI
LA67024104OtherBCBS OF AL
LA0=========1OtherBCBS OF RI
LA4386829440OtherBCBS OF LA