Provider Demographics
NPI:1972721140
Name:MARCINISZYN, KATHERINE T (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:T
Last Name:MARCINISZYN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MASTRO LN # 1
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-3544
Mailing Address - Country:US
Mailing Address - Phone:603-632-9311
Mailing Address - Fax:
Practice Address - Street 1:15 MASTRO LN # 1
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03748-3544
Practice Address - Country:US
Practice Address - Phone:603-632-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00021291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009224Medicaid