Provider Demographics
NPI:1922668599
Name:MARINA, ADAM (DMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MARINA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SW 10TH AVE STE 1102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2712
Mailing Address - Country:US
Mailing Address - Phone:503-966-2002
Mailing Address - Fax:
Practice Address - Street 1:511 SW 10TH AVE STE 1102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2712
Practice Address - Country:US
Practice Address - Phone:503-966-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD120901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice