MEDICARE: DR MARINO AND ASSOCIATES INC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1730660770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MARINO AND ASSOCIATES INC

Provider Business Mailing Address
First Line	:	63 GRAHAM RD STE 3
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1294
Country	:	US
Telephone Number	:	330-920-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5716 BROADWAY AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1715
Country	:	US
Telephone Number	:	216-415-5504
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARLO MARINO
Credential	:	DDS
Telephone Number	:	330-920-8060

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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