Provider Demographics
NPI:1154549194
Name:MARMOR, JEFFREY (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MARMOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-0595
Mailing Address - Country:US
Mailing Address - Phone:845-928-2353
Mailing Address - Fax:845-928-7345
Practice Address - Street 1:478 RT. 32
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930
Practice Address - Country:US
Practice Address - Phone:845-928-2353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0393421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice