Healthcare Provider Details

I. General information

NPI: 1386715993
Provider Name (Legal Business Name): MARCUS DAGER D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 N WABASH AVE
MARION IN
46952-2510
US

IV. Provider business mailing address

1102 N WABASH AVE
MARION IN
46952-2510
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-3881
  • Fax: 765-662-7090
Mailing address:
  • Phone: 765-662-3881
  • Fax: 765-662-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12010856A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: