Healthcare Provider Details

I. General information

NPI: 1871641092
Provider Name (Legal Business Name): DAVID MARTIN MARSHAK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. DAVID MARTIN MARSHAK DDS

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S EL MOLINO AVE #5
PASADENA CA
91101-2985
US

IV. Provider business mailing address

200 S EL MOLINO AVE #5
PASADENA CA
91101-2985
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-5496
  • Fax: 626-793-8961
Mailing address:
  • Phone: 626-796-5496
  • Fax: 626-793-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: