Individual
JEAN MARY ROBERT MARIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
231 WADE ROAD EXT, SUITE 101, LATHAM, NY 12110
(518) 782-1900
(518) 782-1318
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
054456
NY
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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