Provider Demographics
NPI:1487874905
Name:MARINO, JOSEPH B JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:MARINO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7037 CANAL BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3453
Mailing Address - Country:US
Mailing Address - Phone:504-282-5557
Mailing Address - Fax:504-286-0038
Practice Address - Street 1:7037 CANAL BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3453
Practice Address - Country:US
Practice Address - Phone:504-282-5557
Practice Address - Fax:504-286-0038
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA34331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA578120OtherUCCI
LA116446OtherCIGNA HMO
LA67024104OtherBC BS OF AL
LA07210102681OtherBC BS OF RI