Provider Demographics
NPI:1285995894
Name:MARTY, ROLANDO (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:MARTY
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 1:500 GYPSY LN
Mailing Address - Street 2:3RD FLOOR, DENTAL CLINIC
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1315
Mailing Address - Country:US
Mailing Address - Phone:330-884-3058
Mailing Address - Fax:330-884-5788
Practice Address - Street 1:500 GYPSY LN
Practice Address - Street 2:3RD FLOOR, DENTAL CLINIC
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1315
Practice Address - Country:US
Practice Address - Phone:330-884-3058
Practice Address - Fax:330-884-5788
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist