Provider Demographics
NPI:1154597334
Name:MARINAK, DOUGLAS P (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:MARINAK
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 1:19 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4603
Mailing Address - Country:US
Mailing Address - Phone:717-737-7422
Mailing Address - Fax:
Practice Address - Street 1:19 S 22ND ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4603
Practice Address - Country:US
Practice Address - Phone:717-737-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018402L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist