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General NPI Number Information
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NPI Number | 1780734277
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Entity Type | Individual
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Provider Name | MARLEN MARTIROSSIAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 130 KINDERKAMACK RD SUITE 306
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City | RIVER EDGE
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State | NJ
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Zip | 07661-1939
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Country | US
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Telephone | 201-546-8512
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Fax | 201-488-4756
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Provider Business Mailing Address
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Address Line | 130 KINDERKAMACK RD SUITE 306
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City | RIVER EDGE
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State | NJ
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Zip | 07661-1939
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Country | US
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Telephone | 201-546-8512
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Fax | 201-488-4756
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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 | 22DI02140900
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License Number State | NJ
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