Provider Demographics
NPI:1881984649
Name:MARINOFF, JESSICA (DMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARINOFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-1132
Mailing Address - Country:US
Mailing Address - Phone:215-317-5869
Mailing Address - Fax:856-246-3550
Practice Address - Street 1:1000 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-1132
Practice Address - Country:US
Practice Address - Phone:215-317-5869
Practice Address - Fax:856-246-3550
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024648001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0290661Medicaid