Provider Demographics
NPI:1922089820
Name:MARINO, ANGELA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:MARINO
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 1:5507 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2913
Mailing Address - Country:US
Mailing Address - Phone:440-473-3338
Mailing Address - Fax:440-473-1988
Practice Address - Street 1:5507 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2913
Practice Address - Country:US
Practice Address - Phone:440-473-3338
Practice Address - Fax:440-473-1988
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
OH196061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2258186Medicaid