Provider Demographics
NPI:1043007651
Name:MARIN-MARIN, PRISCILLA (DMD)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MARIN-MARIN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2044 BOLIVAR CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2761
Mailing Address - Country:US
Mailing Address - Phone:619-743-0756
Mailing Address - Fax:
Practice Address - Street 1:55 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6017
Practice Address - Country:US
Practice Address - Phone:831-621-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1114361223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health