1487874905 NPI number — DR. JOSEPH B. MARINO JR. D.D.S.

Table of content: DR. JOSEPH B. MARINO JR. D.D.S. (NPI 1487874905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487874905 NPI number — DR. JOSEPH B. MARINO JR. D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARINO
Provider First Name:
JOSEPH
Provider Middle Name:
B.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

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:
1487874905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7037 CANAL BLVD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70124-3453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-282-5557
Provider Business Mailing Address Fax Number:
504-286-0038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7037 CANAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70124-3453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-282-5557
Provider Business Practice Location Address Fax Number:
504-286-0038
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3433 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 578120 . This is a "UCCI" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 116446 . This is a "CIGNA HMO" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 67024104 . This is a "BC BS OF AL" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 07210102681 . This is a "BC BS OF RI" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com