Provider Demographics
NPI:1447452248
Name:MAVRINAC, CATHY ANN MARIE (DDS)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN MARIE
Last Name:MAVRINAC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3418
Mailing Address - Country:US
Mailing Address - Phone:646-508-5345
Mailing Address - Fax:
Practice Address - Street 1:2071 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4101
Practice Address - Country:US
Practice Address - Phone:212-410-6969
Practice Address - Fax:212-410-6989
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050999-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02717077Medicaid