Provider Demographics
NPI:1538278148
Name:DRS MARINO NASSIF & ASSOCIATES INC
Entity type:Organization
Organization Name:DRS MARINO NASSIF & ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:NASSIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-357-6600
Mailing Address - Street 1:2500 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109
Mailing Address - Country:US
Mailing Address - Phone:216-696-1515
Mailing Address - Fax:216-696-1518
Practice Address - Street 1:2500 CLARK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109
Practice Address - Country:US
Practice Address - Phone:216-696-1515
Practice Address - Fax:216-696-1518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS MARINO NASSIF & ASSOCIATES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-29
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2509333Medicaid