Healthcare Provider Details

I. General information

NPI: 1942658141
Provider Name (Legal Business Name): MARION DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 BARRINGTON PKWY SUITE C
MARION IA
52302-9043
US

IV. Provider business mailing address

915 BARRINGTON PKWY SUITE C
MARION IA
52302-9043
US

V. Phone/Fax

Practice location:
  • Phone: 319-377-4867
  • Fax: 319-382-2231
Mailing address:
  • Phone: 319-377-4867
  • Fax: 319-382-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number08498
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LAURA FAUCHIER
Title or Position: PRESIDENT
Credential: DDS
Phone: 319-377-4867