Healthcare Provider Details

I. General information

NPI: 1548369275
Provider Name (Legal Business Name): DRS MARINO NASSIF & ASSICIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SEVERANCE CIR STE 412
CLEVELAND HTS OH
44118-1566
US

IV. Provider business mailing address

5 SEVERANCE CIR STE 412
CLEVELAND HTS OH
44118-1566
US

V. Phone/Fax

Practice location:
  • Phone: 216-541-6434
  • Fax: 216-541-6439
Mailing address:
  • Phone: 216-541-6434
  • Fax: 216-541-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLO MARINO
Title or Position: VICE PRESIDENT
Credential: DDS
Phone: 330-920-8060