Provider Demographics
NPI:1366976763
Name:MARCIANO, MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W 236TH ST
Mailing Address - Street 2:2E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1748
Mailing Address - Country:US
Mailing Address - Phone:201-835-3443
Mailing Address - Fax:
Practice Address - Street 1:530 W 236TH ST
Practice Address - Street 2:2E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1748
Practice Address - Country:US
Practice Address - Phone:201-835-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0595251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry