1831122845 NPI number — MARINAK & GLOSSNER DDS PC

Table of content: (NPI 1831122845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831122845 NPI number — MARINAK & GLOSSNER DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINAK & GLOSSNER DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831122845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 S 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMP HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-737-7422
Provider Business Mailing Address Fax Number:
717-975-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 S 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-737-7422
Provider Business Practice Location Address Fax Number:
717-975-2301
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARINAK
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DENTIST PRESIDENT CEO
Authorized Official Telephone Number:
717-737-7422

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS018402L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: DS030329L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)