Provider Demographics
NPI:1902697733
Name:MACCHIAVERNA, MARC ROCCO (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ROCCO
Last Name:MACCHIAVERNA
Suffix:
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 1:2055 HOWARD CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1800
Mailing Address - Country:US
Mailing Address - Phone:803-600-6910
Mailing Address - Fax:
Practice Address - Street 1:2055 HOWARD CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1800
Practice Address - Country:US
Practice Address - Phone:803-600-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program