Healthcare Provider Details

I. General information

NPI: 1992525372
Provider Name (Legal Business Name): MARSTON-SMITH PS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 S FARRELL DR STE C101
PALM SPRINGS CA
92262-7962
US

IV. Provider business mailing address

14310 EDEN GRV
POWAY CA
92064-2367
US

V. Phone/Fax

Practice location:
  • Phone: 760-320-7621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BLAKE MARSTON
Title or Position: PRESIDENT/ORTHODONTIST
Credential: DDS
Phone: 480-239-8720