MEDICARE: DR. MARYJO MARRO-TOBIN 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	046826	NY

General Provider Information

NPI Number	:	1093738338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYJO MARRO-TOBIN DDS

Provider Business Mailing Address
First Line	:	6200 SLOCUM RD
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-9142
Country	:	US
Telephone Number	:	315-524-7433
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 SLOCUM RD
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-9142
Country	:	US
Telephone Number	:	315-524-7433
Fax Number	:	315-524-2920

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	11/18/2021

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