Healthcare Provider Details

I. General information

NPI: 1982947719
Provider Name (Legal Business Name): ROSS A. MARLEY, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 HALIBUT POINT RD
SITKA AK
99835-7301
US

IV. Provider business mailing address

423 HALIBUT POINT RD
SITKA AK
99835-7301
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-6050
  • Fax: 907-747-3706
Mailing address:
  • Phone: 907-747-6050
  • Fax: 907-747-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1311
License Number StateAK

VIII. Authorized Official

Name: DR. ROSS MARLEY
Title or Position: DENTIST/OWNER
Credential:
Phone: 907-747-6050