Provider Demographics
NPI:1619022639
Name:LUCIANO D. MARINI, DMD LLC
Entity type:Organization
Organization Name:LUCIANO D. MARINI, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-575-9097
Mailing Address - Street 1:26 LAKESIDE BLVD E
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2913
Mailing Address - Country:US
Mailing Address - Phone:203-575-9097
Mailing Address - Fax:203-575-0824
Practice Address - Street 1:26 LAKESIDE BLVD E
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2913
Practice Address - Country:US
Practice Address - Phone:203-575-9097
Practice Address - Fax:203-575-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty