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General NPI Number Information
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NPI Number | 1770674814
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Entity Type | Individual
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Provider Name | MARC MALATESTA DDS
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 3770 MOUNT READ BLVD
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City | ROCHESTER
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State | NY
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Zip | 14616-3436
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Country | US
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Telephone | 585-865-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 78 OLD ENGLISH DR
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City | ROCHESTER
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State | NY
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Zip | 14616-1950
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Country | US
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Telephone | 716-560-3230
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 053606
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS036926
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50 053606
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License Number State | NY
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