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General NPI Number Information
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NPI Number | 1831122845
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Entity Type | Organization
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Legal Business Name | MARINAK & GLOSSNER DDS PC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19 S 22ND ST
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City | CAMP HILL
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State | PA
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Zip | 17011
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Country | US
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Telephone | 717-737-7422
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Fax | 717-975-2301
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Provider Business Mailing Address
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Address Line | 19 S 22ND ST
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City | CAMP HILL
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State | PA
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Zip | 17011
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Country | US
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Telephone | 717-737-7422
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Fax | 717-975-2301
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Authorized Official
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Title or Position | DENTIST PRESIDENT CEO
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Name | DR. DOUGLAS P MARINAK
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Credential | DDS
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Telephone | 717-737-7422
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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 | DS030329L
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License Number State | PA
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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 | DS018402L
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License Number State | PA
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