Provider Demographics
NPI:1811169774
Name:SAUCO, MARINA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:SAUCO
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 1:1619 N. 9TH STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353
Mailing Address - Country:US
Mailing Address - Phone:570-426-1868
Mailing Address - Fax:570-426-1867
Practice Address - Street 1:1619 N. 9TH STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18353
Practice Address - Country:US
Practice Address - Phone:570-426-1868
Practice Address - Fax:570-426-1867
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030925L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics