Provider Demographics
NPI:1912057019
Name:MARINO, ERNEST MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:MICHAEL
Last Name:MARINO
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 1:614 NASHUA ST
Mailing Address - Street 2:#65
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 ALLDS ST
Practice Address - Street 2:STE 4
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4757
Practice Address - Country:US
Practice Address - Phone:603-883-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH11461223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics