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General NPI Number Information
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NPI Number | 1760609275
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Entity Type | Organization
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Legal Business Name | GLENN J. MARIE, DDS, PC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 739 WOODROW RD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2221
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Country | US
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Telephone | 718-317-8524
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Fax | 718-984-6644
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Provider Business Mailing Address
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Address Line | PO BOX 4038
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-4038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | DR. GLENN J. MARIE
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Credential | DDS
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Telephone | 718-317-8524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 040958
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License Number State | NY
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