Provider Demographics
NPI:1144366451
Name:MARCINKO, DENNIS RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RICHARD
Last Name:MARCINKO
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 1:332 W PATRIOT ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1522
Mailing Address - Country:US
Mailing Address - Phone:814-443-4747
Mailing Address - Fax:
Practice Address - Street 1:332 W PATRIOT ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1522
Practice Address - Country:US
Practice Address - Phone:814-443-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPADS022909L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice