Provider Demographics
NPI:1588874598
Name:MARO, PETER DANIEL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:DANIEL
Last Name:MARO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 PURCHASE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2102
Mailing Address - Country:US
Mailing Address - Phone:914-967-2277
Mailing Address - Fax:
Practice Address - Street 1:262 PURCHASE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2102
Practice Address - Country:US
Practice Address - Phone:914-967-2277
Practice Address - Fax:914-967-2292
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-05-25
Deactivation Date:2020-06-29
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
NY047599-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics