Provider Demographics
NPI:1376639773
Name:MARCIANO, GILA (DDS)
Entity type:Individual
Prefix:DR
First Name:GILA
Middle Name:
Last Name:MARCIANO
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 1:15 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2910
Mailing Address - Country:US
Mailing Address - Phone:845-641-8987
Mailing Address - Fax:
Practice Address - Street 1:12 N AIRMONT RD STE 4A
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5136
Practice Address - Country:US
Practice Address - Phone:845-357-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP512911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice