Provider Demographics
NPI:1336273929
Name:BURDUSI, MARINA ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:ROSE
Last Name:BURDUSI
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 1:662 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-2220
Mailing Address - Country:US
Mailing Address - Phone:410-625-9444
Mailing Address - Fax:
Practice Address - Street 1:10 W BROADWAY
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3555
Practice Address - Country:US
Practice Address - Phone:410-385-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice