Provider Demographics
NPI:1720259740
Name:MAURO, MARIANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:MAURO
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 1:11 CLAYTON CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2902
Mailing Address - Country:US
Mailing Address - Phone:732-718-4607
Mailing Address - Fax:732-819-7669
Practice Address - Street 1:11 CLAYTON CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2902
Practice Address - Country:US
Practice Address - Phone:732-718-4607
Practice Address - Fax:732-819-7669
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01711700122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5446104Medicaid