Provider Demographics
NPI:1700882552
Name:MARINACCIO, WARREN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:G
Last Name:MARINACCIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E WALDO BLVD
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2908
Mailing Address - Country:US
Mailing Address - Phone:920-682-2273
Mailing Address - Fax:920-682-0117
Practice Address - Street 1:201 E WALDO BLVD
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2908
Practice Address - Country:US
Practice Address - Phone:920-682-2273
Practice Address - Fax:920-682-0117
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist