Healthcare Provider Details

I. General information

NPI: 1558194829
Provider Name (Legal Business Name): CAROLINE MARLIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 W WASHINGTON ST
MONTICELLO GA
31064-1368
US

IV. Provider business mailing address

458 W WASHINGTON ST
MONTICELLO GA
31064-1368
US

V. Phone/Fax

Practice location:
  • Phone: 706-468-6394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123588
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: