Provider Demographics
NPI:1316503261
Name:MARRERO MARRERO, IRMARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:IRMARIE
Middle Name:
Last Name:MARRERO MARRERO
Suffix:
Gender:F
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:URB. SOBRINO
Mailing Address - Street 2:CALLE E BLOQUE A-20
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-702-8227
Mailing Address - Fax:
Practice Address - Street 1:A20 CALLE E
Practice Address - Street 2:URBANIZACION SOBRINO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0303
Practice Address - Country:US
Practice Address - Phone:787-702-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0033441223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program