Provider Demographics
NPI:1962633123
Name:DR. BERNADETTE MARINO DDS PC
Entity Type:Organization
Organization Name:DR. BERNADETTE MARINO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-628-1757
Mailing Address - Street 1:58 MIDDAGH ST
Mailing Address - Street 2:APT 11
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1380
Mailing Address - Country:US
Mailing Address - Phone:917-628-1757
Mailing Address - Fax:
Practice Address - Street 1:58 MIDDAGH ST
Practice Address - Street 2:APT 11
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1380
Practice Address - Country:US
Practice Address - Phone:917-628-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty