Provider Demographics
NPI:1144312158
Name:COZZARIN, MARC ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:COZZARIN
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 1:96 FRANKLIN CORNER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-896-0100
Mailing Address - Fax:
Practice Address - Street 1:96 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-896-0100
Practice Address - Fax:609-896-9046
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist