Healthcare Provider Details

I. General information

NPI: 1013845452
Provider Name (Legal Business Name): MARINA F BOCTOR DMD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S 5TH AVE
DENTON MD
21629-1398
US

IV. Provider business mailing address

808 S 5TH AVE
DENTON MD
21629-1398
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-2650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: