MEDICARE: DR. KAREN LILIANA MARINO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25707	TX

General Provider Information

NPI Number	:	1023311339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN LILIANA MARINO DDS

Provider Business Mailing Address
First Line	:	2606 EDGEFIELD LAKES DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-6006
Country	:	US
Telephone Number	:	713-218-0512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2606 EDGEFIELD LAKES DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-6006
Country	:	US
Telephone Number	:	713-218-0512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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