MEDICARE: ANTHONY J. MARINO, D.D.S. , P.C.

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	13493	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477597888	OTHER	MO	INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1093872731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY J. MARINO, D.D.S. , P.C.

Provider Business Mailing Address
First Line	:	7004 LANSDOWNE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1950
Country	:	US
Telephone Number	:	314-645-7247
Fax Number	:	314-645-5649

Provider Business Practice Location Address
First Line	:	7004 LANSDOWNE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1950
Country	:	US
Telephone Number	:	314-645-7247
Fax Number	:	314-645-5649

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANTHONY JOSEPH MARINO
Credential	:	D.D.S.
Telephone Number	:	314-645-7247

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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