Individual
DR. MARINA MAZIANITOU GOTTFRIED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
2615 23RD AVE, ASTORIA, NY 11105-3124
(718) 267-0641
Mailing address
2615 23RD AVE, ASTORIA, NY 11105-3124
(718) 267-0641
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
041176-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01574510
—
NY
Enumeration date
05/01/2008
Last updated
05/01/2008
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