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General NPI Number Information
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NPI Number | 1861535361
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Entity Type | Individual
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Provider Name | COSTIN MARINESCU D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1040 N CHERRY ST
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City | TULARE
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State | CA
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Zip | 93274-2251
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Country | US
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Telephone | 559-686-1773
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 FEDERAL AVE UNIT 104
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City | LOS ANGELES
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State | CA
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Zip | 90025-3972
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Country | US
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Telephone | 310-849-0546
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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 | 52429
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License Number State | CA
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