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General NPI Number Information
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NPI Number | 1497948475
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Entity Type | Individual
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Provider Name | MARICARMEN JUSTINIANO D.M.D
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Gender | Female
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 5875 S TRANSIT RD
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City | LOCKPORT
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State | NY
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Zip | 14094-6340
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Country | US
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Telephone | 716-280-1001
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Fax | 716-280-1005
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Provider Business Mailing Address
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Address Line | 28 SAINT ANTHONY ST
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City | LANCASTER
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State | NY
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Zip | 14086-2388
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Country | US
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Telephone | 716-208-3222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 053197-1
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License Number State | NY
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