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General NPI Number Information
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NPI Number | 1891563961
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Entity Type | Organization
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Legal Business Name | MARMOR NY DENTAL PC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 306 GRANT AVE
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City | AUBURN
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State | NY
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Zip | 13021-1404
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Country | US
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Telephone | 914-835-6004
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Fax | 914-560-2216
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Provider Business Mailing Address
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Address Line | 76 PROGRESS DR STE 123
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City | STAMFORD
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State | CT
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Zip | 06902-3603
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Country | US
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Telephone | 914-835-6004
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Fax | 914-560-2216
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Authorized Official
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Title or Position | CEO
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Name | RACHEL MARMOR
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Credential | DDS
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Telephone | 914-835-6004
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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 |
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License Number State |
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