Provider Demographics
NPI:1740487412
Name:MATS, MARINA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:MATS
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 1:17 PARK PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2514
Mailing Address - Country:US
Mailing Address - Phone:212-732-2200
Mailing Address - Fax:212-732-2249
Practice Address - Street 1:17 PARK PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2514
Practice Address - Country:US
Practice Address - Phone:212-732-2200
Practice Address - Fax:212-732-2249
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049887-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist